MODAFINIL 100 MG TABLET [Provigil] (NDC: 00378557393)
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 | 2 |
Tier 2 |
25% | 25% | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:68 /34Days | $316.34 |
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 0 (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $17.50 | P Q:60 /30Days | $321.06 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
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 | 4 |
Tier 4 |
25% | 25% | P Q:60 /30Days | $394.19 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | P Q:60 /30Days | $325.49 |
Browse Plan Formulary |
McLarenAdvantage (HMO SNP)
|
$32.50 |
$310* | No additional gap coverage, only the Donut Hole Discount | 1* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $425.69 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
|
$48.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $17.50 | P Q:60 /30Days | $311.16 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$56.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$68.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
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 |
PriorityMedicare Merit (PPO)
|
$68.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$68.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$68.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$68.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
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)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $17.50 | P Q:60 /30Days | $321.06 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
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)
|
$113.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
McLarenAdvantage (HMO)
|
$128.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$5.00 | n/a | P Q:30 /30Days | $425.69 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$134.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$146.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
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 |
PriorityMedicare Select (PPO)
|
$146.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$146.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$146.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$146.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:62 /31Days | $345.12 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 | Many Generics | 1 |
Generic |
$6.00 | $15.00 | P Q:60 /30Days | $321.06 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:180 /90Days | $316.34 |
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)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$6.00 | $15.00 | P Q:60 /30Days | $311.16 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
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)
|
$241.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:68 /34Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:180 /90Days | $316.34 |
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)
|
$268.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:180 /90Days | $316.34 |
Browse Plan Formulary |