ONFI 2.5 MG/ML SUSPENSION (120 ML ) (NDC: 67386031321)
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% | Q:544 /34Days | $561.10 |
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% | Q:544 /34Days | $561.10 |
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% | Q:544 /34Days | $561.10 |
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% | Q:544 /34Days | $561.10 |
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% | Q:544 /34Days | $561.10 |
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 |
4 |
Non-Preferred Brand |
$85.00 | $255.00 | None | $543.95 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$9.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | S | $546.33 |
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:480 /30Days | $561.10 |
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:480 /30Days | $561.10 |
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:480 /30Days | $561.10 |
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:480 /30Days | $561.10 |
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:480 /30Days | $561.10 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $546.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $546.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $546.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $546.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$27.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $546.33 |
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:480 /30Days | $550.00 |
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 | $543.95 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$39.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $561.10 |
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 |
4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
HumanaChoice H5216-010 (PPO)
|
$52.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:480 /30Days | $550.00 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$80.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:480 /30Days | $550.00 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | Q:544 /34Days | $561.10 |
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 |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$85.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$92.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | S | $546.33 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
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 |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | S | $546.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | S | $546.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | S | $546.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$101.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | S | $546.33 |
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 |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | S | $546.33 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$169.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:480 /30Days | $561.10 |
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 |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$216.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | Q:544 /34Days | $561.10 |
Browse Plan Formulary |