BLEPHAMIDE 0.2% EYE DROPS (10 ML BOT) (NDC: 11980002210)
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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $186.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $186.27 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $187.78 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $186.23 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $187.16 |
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 Value (HMO-POS)
|
$9.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $185.89 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $187.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $186.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $185.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $187.78 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $186.29 |
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)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $185.62 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $185.88 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $185.84 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $184.80 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $185.89 |
Browse Plan Formulary |
HumanaChoice R5826-006 P (Regional PPO)
|
$30.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $180.38 |
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)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $186.29 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $187.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $186.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $185.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $187.78 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $186.23 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $187.16 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $186.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $186.27 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $187.78 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$92.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $185.89 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $185.85 |
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)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $187.78 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $186.29 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $187.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $186.15 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $184.80 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $185.89 |
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)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $185.62 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $185.88 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $185.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $186.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $185.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $187.78 |
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)
|
$169.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $186.29 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $187.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | None | $187.16 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | None | $186.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | None | $187.78 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | None | $186.27 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | None | $186.23 |
Browse Plan Formulary |