Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE (100 TABLET BOTTLE ) (NDC: 00378041501)
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 |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
Some Generics |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $27.83 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Premier (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None | $27.83 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
Few Generics |
1 |
Generic |
$10.00 | $20.00 | P | $86.46 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $32.64 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $32.64 |
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 |
Brand New Day Dementia with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None | $88.80 |
Browse Plan Formulary |
Brand New Day Diabetes with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None | $88.80 |
Browse Plan Formulary |
Brand New Day Enhanced Drug Savings for So Cal (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None | $88.63 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $88.38 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $122.12 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $122.12 |
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 |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $122.12 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $122.12 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $122.12 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $122.12 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $121.75 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $88.40 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $86.48 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $86.48 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $86.48 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $86.48 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $86.48 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $86.48 |
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 |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $86.48 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $116.37 |
Browse Plan Formulary |
Humana Gold Plus H0108-013 (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $73.19 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $107.43 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $116.37 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $116.18 |
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 |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $116.18 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$4.00 |
$0 |
to be determined |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $108.08 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$14.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $108.08 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$16.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $27.78 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$21.90 |
$310 |
Few Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $87.66 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$24.90 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $116.18 |
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 |
Coordinated Choice Plan (HMO)
|
$26.30 |
$310 |
Few Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $88.16 |
Browse Plan Formulary |
Brand New Day Dementia with Extra Care (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $88.80 |
Browse Plan Formulary |
Brand New Day Diabetes with Extra Care (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $88.80 |
Browse Plan Formulary |
Brand New Day Dual Coverage (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $88.80 |
Browse Plan Formulary |
Brand New Day Extra Care (HMO)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $88.80 |
Browse Plan Formulary |
Brand New Day for Mental Illness (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $88.80 |
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 |
Easy Choice Plus Plan (HMO)
|
$28.10 |
$310* |
Call plan for details |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $87.16 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $86.48 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None | $86.46 |
Browse Plan Formulary |
VillageHealth (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $116.37 |
Browse Plan Formulary |