AZOR 10MG-20MG TABLET (90 BOT) (NDC: 65597011190)
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 |
Commonwealth Care Alliance (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Tier 2 |
0% | 0% | None | $163.27 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $158.18 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.88 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.82 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.88 |
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 |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $158.30 |
Browse Plan Formulary |
Fallon Total Care (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Tier 2 |
0% | 0% | Q:30 /30Days | $158.02 |
Browse Plan Formulary |
Network Health Unify (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Tier 2 |
0% | 0% | None | $158.78 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | None | $158.98 |
Browse Plan Formulary |
UnitedHealthcare Senior Care Options (HMO SNP)
|
$13.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
n/a | n/a | None | $159.72 |
Browse Plan Formulary |
AARP MedicareComplete Choice (Regional PPO)
|
$19.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $159.24 |
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 |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$22.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
n/a | n/a | None | $158.78 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS SNP)
|
$26.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $110.00 | None | $159.23 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$26.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $159.72 |
Browse Plan Formulary |
NaviCare (HMO SNP)
|
$28.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
25% | 25% | Q:30 /30Days | $158.01 |
Browse Plan Formulary |
Senior Care Options Program (HMO SNP)
|
$30.90 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | None | $163.92 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$35.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $159.07 |
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 |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$35.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $158.27 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$35.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $158.83 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $158.30 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $158.18 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.82 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.88 |
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 |
Erickson Advantage Freedom (HMO-POS)
|
$48.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $159.20 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$117.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $158.27 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$117.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $158.83 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$117.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $159.07 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$143.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $158.30 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$143.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $158.18 |
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 |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$143.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.88 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$143.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.82 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$143.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$76.00 | $228.00 | Q:30 /30Days | $157.88 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$151.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $158.27 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$151.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $158.83 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$151.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $105.00 | None | $159.07 |
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 |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$185.70 |
$0 |
Many Generics |
3 |
Preferred Brand |
$30.00 | $90.00 | None | $158.83 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$185.70 |
$0 |
Many Generics |
3 |
Preferred Brand |
$30.00 | $90.00 | None | $159.07 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$185.70 |
$0 |
Many Generics |
3 |
Preferred Brand |
$30.00 | $90.00 | None | $158.27 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$189.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $159.20 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$189.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $159.20 |
Browse Plan Formulary |