GLYBURIDE 2.5MG TABLET (100 CT) (100 TABLETS BOT) (NDC: 00093834301)
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 |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Few Generics |
1 |
Generic |
$10.00 | $20.00 | None | $6.36 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P Q:240 /30Days | $5.59 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | S Q:240 /30Days | $9.26 |
Browse Plan Formulary |
AvMed Medicare Choice Elect (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$4.00 | $0.00 | S Q:240 /30Days | $9.26 |
Browse Plan Formulary |
BlueMedicare HMO LifeTime (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$50.00 | $150.00 | P Q:240 /30Days | $5.85 |
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 |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$50.00 | $150.00 | P Q:240 /30Days | $5.85 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$30 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P Q:240 /30Days | $5.89 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
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 |
Clear Skies (HMO SNP)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | P Q:240 /30Days | $7.75 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$35.00 | $105.00 | S | $12.44 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$60.00 | $180.00 | S | $12.44 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$30.00 | $90.00 | S | $12.44 |
Browse Plan Formulary |
Day Break (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | P Q:240 /30Days | $7.75 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | S | $5.94 |
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 |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | S | $5.93 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | S | $5.93 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | S | $5.93 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | S | $5.93 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | P | $6.36 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
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 |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-188 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$150* |
Few Generics, Few Brands |
2* |
Non-Preferred Generic |
$15.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$0.00 | n/a | None | $8.96 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | S | $5.93 |
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 |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | S | $5.93 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | n/a | P | $8.87 |
Browse Plan Formulary |
Preferred Medical Plan Choice (HMO)
|
$0.00 |
$0 |
Many Generics, Many Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P Q:30 /30Days | $8.68 |
Browse Plan Formulary |
Preferred Medical Plan Value (HMO)
|
$0.00 |
$0 |
Some Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | P Q:30 /30Days | $8.68 |
Browse Plan Formulary |
Simply Clear (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
25% | n/a | P | $4.36 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $4.36 |
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 |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $4.36 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $4.36 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $4.36 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
1 |
Preferred Generic |
$0.00 | n/a | P | $6.36 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
1 |
Preferred Generic |
$0.00 | n/a | P | $6.36 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | P Q:240 /30Days | $7.75 |
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 |
Sunny Days (HMO SNP)
|
$3.60 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | P Q:240 /30Days | $7.75 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-187 (HMO SNP)
|
$7.80 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
WellCare Select (HMO SNP)
|
$11.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$4.00 | $8.00 | P Q:124 /31Days | $6.81 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$11.80 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$12.10 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | P Q:124 /31Days | $6.76 |
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 |
CareNeeds PLUS (HMO SNP)
|
$13.60 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$17.50 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$17.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | P Q:124 /31Days | $6.76 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$18.90 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$76.00 | $228.00 | S | $12.40 |
Browse Plan Formulary |
Advantage by Sunshine Health (HMO SNP)
|
$21.00 |
$310* |
Many Generics |
1* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $6.23 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$22.00 |
$310* |
Many Generics, Few Brands |
1* |
Generic |
$0.00 | $0.00 | P Q:240 /30Days | $5.81 |
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 |
Amerivantage Specialty + Rx (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | P Q:240 /30Days | $5.59 |
Browse Plan Formulary |
Coventry Vista Maximum (HMO SNP)
|
$22.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$76.00 | $228.00 | S | $12.40 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$22.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$76.00 | $228.00 | S | $12.40 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | S | $5.94 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S | $5.94 |
Browse Plan Formulary |
MediMax (HMO)
|
$22.10 |
$310 |
Call plan for details |
1 |
Preferred Generic |
25% | n/a | P | $6.39 |
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 |
Optimum Emerald Full (HMO SNP)
|
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | S | $5.94 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S | $5.94 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$22.10 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | P | $4.36 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$22.10 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | P | $4.36 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$22.10 |
$310* |
Many Generics |
1* |
Preferred Generic |
$0.00 | $0.00 | P | $4.36 |
Browse Plan Formulary |
Touch Institutional Special Needs Plan (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | P Q:240 /30Days | $5.59 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$35.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$4.00 | $8.00 | None | $6.36 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$36.60 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$8.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$45.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$103.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$15.00 | $0.00 | P | $5.09 |
Browse Plan Formulary |