Ketek 300mg/1 20 FILM COATED TABLETS in BOTTLE (20 TABLET, FILM COATED in ) (NDC: 00088222320)
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 | 4 |
Tier 4 |
25% | 25% | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $1,032.95 |
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 |
Fidelis Secure Respect (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $1,020.17 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | S | $1,026.93 |
Browse Plan Formulary |
Meridian Prime (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$85.00 | $255.00 | P | $1,001.16 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
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 | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$27.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | P | $1,024.60 |
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 | $1,012.63 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | S | $1,026.93 |
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 | P | $1,001.16 |
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 |
Midwest Advantage (HMO SNP)
|
$32.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Brand |
$0.00 | n/a | None | $1,006.28 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
|
$48.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | S | $1,026.93 |
Browse Plan Formulary |
Fidelis Secure Premier (HMO)
|
$52.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $1,020.17 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$58.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,051.24 |
Browse Plan Formulary |
BCN Advantage HMO Local (HMO)
|
$66.00 |
$50 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $1,032.95 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$73.00 |
$200 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,051.24 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | S | $1,026.93 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$99.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,051.24 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
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)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$124.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,051.24 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $1,032.95 |
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)
|
$130.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $1,026.93 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | S | $1,026.93 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$179.00 |
$50 | All Generics | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,051.24 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$203.00 |
$150 | All Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $1,051.24 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $1,032.95 |
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)
|
$246.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $1,032.95 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
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)
|
$272.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:20 /10Days | $1,032.95 |
Browse Plan Formulary |