ALTOPREV 20MG TABLET SR 24HR (30 BOT) (NDC: 59630062830)
2014 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $477.17 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $485.72 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $488.24 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $479.45 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
n/a | n/a | None | $477.17 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
|
$48.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $477.82 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$60.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $482.03 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $479.45 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $485.72 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $488.24 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $477.17 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $482.03 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $486.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $479.09 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $479.36 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $486.03 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$138.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $482.03 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $479.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $485.72 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $488.24 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $477.17 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $479.36 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $486.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $482.03 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $486.87 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $479.09 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $477.82 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $488.24 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $479.45 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $491.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:90 /90Days | $485.72 |
Browse Plan Formulary |