LEXIVA 700MG TABLETS (60 BOT ) (NDC: 49702020718)
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 | 5 |
Tier 5 |
25% | 25% | None | $980.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $972.57 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $988.57 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $981.22 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $985.18 |
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 |
Meridian Prime (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | None | $954.18 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$9.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.53 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $980.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $976.32 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $986.99 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $979.61 |
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 | 5 |
Tier 5 |
25% | 25% | None | $989.98 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $978.68 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.74 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.53 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $971.76 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.42 |
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 | 5 |
Tier 5 |
25% | 25% | Q:120 /30Days | $949.59 |
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 | $954.18 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $989.98 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $979.61 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $986.99 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $976.32 |
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 | 5 |
Tier 5 |
25% | 25% | None | $980.80 |
Browse Plan Formulary |
HumanaChoice H5216-010 (PPO)
|
$52.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | Q:120 /30Days | $950.07 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$80.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | Q:120 /30Days | $947.72 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $980.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $972.57 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $988.57 |
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 | 5 |
Specialty Tier |
33% | n/a | None | $981.22 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $985.18 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$92.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.53 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $989.98 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $979.61 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $986.99 |
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 | 5 |
Specialty Tier |
33% | n/a | None | $976.32 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $980.80 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $978.68 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.53 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.74 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $970.42 |
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 | 4 |
Specialty Tier |
33% | n/a | None | $971.76 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $989.98 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $979.61 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $986.99 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $976.32 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $980.80 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $980.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $972.57 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $988.57 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $981.22 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $985.18 |
Browse Plan Formulary |