REGRANEX 0.01% GEL (15 GM ) (NDC: 00064081015)
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% | P | $908.23 |
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% | P | $909.42 |
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% | P | $913.11 |
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% | P | $910.04 |
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% | P | $913.74 |
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 | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:30 /30Days | $913.23 |
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 | $908.23 |
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 | $910.45 |
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 | $913.11 |
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 | $910.04 |
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 | $914.51 |
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% | None | $882.27 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$32.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $895.34 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:45 /90Days | $897.82 |
Browse Plan Formulary |
Fidelis Secure Freedom (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:45 /90Days | $897.82 |
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 | P Q:30 /30Days | $912.77 |
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 | P Q:30 /30Days | $911.77 |
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 H5216-010 (PPO)
|
$52.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | None | $884.73 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$60.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $915.26 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $914.51 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $910.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $908.23 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $910.45 |
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 | 5 |
Tier 5 |
25% | 25% | None | $913.11 |
Browse Plan Formulary |
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 | P Q:30 /30Days | $913.23 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $909.97 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $908.88 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $915.26 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $913.69 |
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)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $914.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | P | $910.04 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | P | $909.42 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | P | $913.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | P | $913.74 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | P | $908.23 |
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 (HMO-POS)
|
$138.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $915.26 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:30 /30Days | $913.23 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $910.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $913.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $910.45 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $908.23 |
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 | 5 |
Specialty Tier |
33% | n/a | None | $914.51 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $915.26 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $908.88 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $909.97 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $914.88 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $913.69 |
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 AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:30 /30Days | $911.77 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | P | $908.23 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | P | $909.42 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | P | $913.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | P | $910.04 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | P | $913.74 |
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 | 5 |
Specialty Tier |
33% | n/a | None | $914.51 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $910.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $913.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $910.45 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | None | $908.23 |
Browse Plan Formulary |