DAPSONE TABLETS 100MG 30 BLPK (30 BLPK) (NDC: 49938010130)
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 | $35.22 |
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 | $34.94 |
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 | $35.04 |
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 | $35.14 |
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 | $35.13 |
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 |
Meridian Prime (HMO)
|
$0.00 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$5.00 | $15.00 | None | $24.52 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$9.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $31.50 |
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 | $35.22 |
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 | $35.04 |
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 | $35.00 |
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 | $35.10 |
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 | 3 |
Tier 3 |
25% | 25% | None | $35.13 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $32.27 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $33.66 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $31.50 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $32.94 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $32.97 |
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 |
HumanaChoice R5826-006 P (Regional PPO)
|
$30.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $42.51 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $24.52 |
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 | $35.13 |
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 | $35.10 |
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 | $35.00 |
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 | $35.04 |
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 | $35.22 |
Browse Plan Formulary |
HumanaChoice H5216-010 (PPO)
|
$52.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $42.00 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$80.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $42.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.22 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $34.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.04 |
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 | $35.14 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.13 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$92.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $31.50 |
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 | $35.13 |
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 | $35.10 |
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 | $35.00 |
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 | $35.04 |
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 | $35.22 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $32.27 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $31.50 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $33.66 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $32.97 |
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 | 1 |
Generic |
$8.00 | $20.00 | None | $32.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.13 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.00 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $35.22 |
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 | $35.22 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $34.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $35.04 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $35.14 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $35.13 |
Browse Plan Formulary |