OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT) (100 BOT) (NDC: 00093520801)
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 |
AHM Classic (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $85.26 |
Browse Plan Formulary |
AHM Classic Plus (HMO SNP)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$8.00 | $16.00 | None | $85.26 |
Browse Plan Formulary |
AHM Platino Plus (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $85.26 |
Browse Plan Formulary |
AHM Standard (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$8.00 | $16.00 | None | $85.26 |
Browse Plan Formulary |
Apollo - Constellation Health (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 1 |
Generic |
$5.00 | $15.00 | None | $87.63 |
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 |
First Care+Plus (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $88.97 |
Browse Plan Formulary |
First+Plus Advantage Plus (PPO)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $88.97 |
Browse Plan Formulary |
First+Plus Complete (HMO SNP)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $88.97 |
Browse Plan Formulary |
First+Plus Platino (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $88.97 |
Browse Plan Formulary |
First+Plus Smart Premium (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $88.97 |
Browse Plan Formulary |
First+Plus Smart Value (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $88.97 |
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 |
Genesis - Constellation Health (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $87.63 |
Browse Plan Formulary |
Humana Gold Plus H4007-012 (HMO)
|
$0.00 |
$310* | Few Generics, Few Brands | 2* |
Preferred Brand |
$15.00 | $35.00 | Q:60 /30Days | $58.19 |
Browse Plan Formulary |
Humana Gold Plus H4007-013 (HMO)
|
$0.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $58.19 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4007-005 (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | 25% | Q:60 /30Days | $58.19 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4007-016 (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | 25% | Q:60 /30Days | $58.19 |
Browse Plan Formulary |
MCS Classicare B-Max (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $81.82 |
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 |
MCS Classicare Essential (HMO-POS)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:60 /30Days | $81.82 |
Browse Plan Formulary |
MCS Classicare InteliCare (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:60 /30Days | $81.82 |
Browse Plan Formulary |
MCS Classicare Platino Ideal (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $81.82 |
Browse Plan Formulary |
MCS Classicare Platino M
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $81.82 |
Browse Plan Formulary |
MCS Classicare Platino Superior (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $81.82 |
Browse Plan Formulary |
MCS Classicare Premium Health (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:60 /30Days | $81.82 |
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 y Mucho Mas - BASICO EXTRA (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $80.52 |
Browse Plan Formulary |
Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $80.52 |
Browse Plan Formulary |
Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $80.52 |
Browse Plan Formulary |
Medicare y Mucho Mas - ELITE ULTRA (HMO-POS)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$10.00 | $20.00 | None | $80.52 |
Browse Plan Formulary |
Medicare y Mucho Mas - UNICO EXTRA (HMO)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$7.00 | $14.00 | None | $80.52 |
Browse Plan Formulary |
PMC Max - EXTRA (HMO-POS)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$10.00 | $20.00 | None | $80.52 |
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 |
Premier Preferred (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $80.52 |
Browse Plan Formulary |
Triple-S Medicare Optimo Select (HMO) (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $85.26 |
Browse Plan Formulary |
Triple-S Medicare Selecto with Medicare Platino (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $85.26 |
Browse Plan Formulary |
PMC Max (HMO)
|
$10.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$7.00 | $14.00 | None | $80.52 |
Browse Plan Formulary |
Medicare y Mucho Mas - Unico (HMO)
|
$25.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$4.00 | $8.00 | None | $80.52 |
Browse Plan Formulary |
Triple-S Medicare Optimo Premier (HMO)
|
$27.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $85.26 |
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 |
AHM Opal (HMO-POS)
|
$33.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $85.26 |
Browse Plan Formulary |
Medicare y Mucho Mas - ELITE (HMO-POS)
|
$33.50 |
$0 | Some Generics | 1 |
Preferred Generic |
$4.00 | $8.00 | None | $80.52 |
Browse Plan Formulary |
Medicare y Mucho Mas - SUPREMO (HMO SNP)
|
$34.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $80.52 |
Browse Plan Formulary |
Elite Dorado (HMO-POS)
|
$34.50 |
$0 | Some Generics | 1 |
Preferred Generic |
$5.00 | $10.00 | None | $80.52 |
Browse Plan Formulary |
HumanaChoice H2029-001 (PPO)
|
$45.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $58.19 |
Browse Plan Formulary |
Olympus - Constellation Health (PPO)
|
$51.00 |
$0 | Many Generics, Few Brands | 1 |
Generic |
$5.00 | $15.00 | None | $87.63 |
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 |
Alpha - Constellation Health (HMO SNP)
|
$62.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$8.00 | $24.00 | None | $87.63 |
Browse Plan Formulary |
Triple-S Medicare Optimo Plus (PPO)
|
$73.00 |
$0 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $85.26 |
Browse Plan Formulary |
Medicare y Mucho Mas - ELITE EXTRA (HMO-POS)
|
$76.30 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $80.52 |
Browse Plan Formulary |
MCS Classicare Advanced Health (HMO-POS)
|
$79.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$3.00 | $3.00 | Q:60 /30Days | $81.82 |
Browse Plan Formulary |
HumanaChoice H2029-002 (PPO)
|
$103.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$30.00 | $80.00 | Q:60 /30Days | $58.19 |
Browse Plan Formulary |