TEKTURNA HCT 150-12.5MG TABLET (30 BOT) (NDC: 00078052115)
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 |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | Few Generics | 2 |
Preferred Brand |
$45.00 | $90.00 | Q:1 /1Days | $118.84 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $117.48 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$5.00 | $15.00 | Q:30 /30Days | $119.89 |
Browse Plan Formulary |
AvMed Medicare Choice Elect (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $105.00 | Q:30 /30Days | $119.89 |
Browse Plan Formulary |
BlueMedicare HMO LifeTime (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$25.00 | $75.00 | Q:30 /30Days | $117.96 |
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 |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$25.00 | $75.00 | Q:30 /30Days | $117.96 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$30 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days | $117.92 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $116.72 |
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 |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 2 |
Preferred Brand |
$0.00 | $0.00 | S Q:30 /30Days | $121.97 |
Browse Plan Formulary |
Day Break (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Preferred Brand |
$0.00 | $0.00 | S Q:30 /30Days | $121.97 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $120.50 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $120.53 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $120.53 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $120.53 |
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 |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $120.53 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
33% | n/a | None | $117.75 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-188 (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $116.72 |
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 R5826-074 (Regional PPO)
|
$0.00 |
$150* | Few Generics, Few Brands | 3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.69 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Brand |
$0.00 | n/a | None | $117.45 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $120.36 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$69.00 | $138.00 | S Q:30 /30Days | $120.36 |
Browse Plan Formulary |
Simply Clear (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
25% | n/a | None | $115.93 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$55.00 | n/a | None | $115.95 |
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 |
Simply Level (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$15.00 | n/a | None | $115.95 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$10.00 | n/a | None | $115.95 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$30.00 | n/a | None | $115.95 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$0.00 | n/a | None | $117.75 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$0.00 | n/a | None | $117.75 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Preferred Brand |
$0.00 | $0.00 | S Q:30 /30Days | $121.97 |
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 |
Sunny Days (HMO SNP)
|
$3.60 |
$0 | All Generics | 2 |
Preferred Brand |
25% | 25% | S Q:30 /30Days | $121.97 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-187 (HMO SNP)
|
$7.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
WellCare Select (HMO SNP)
|
$11.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$88.00 | $176.00 | Q:31 /31Days | $120.56 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$11.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$12.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$84.00 | $168.00 | Q:31 /31Days | $120.43 |
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 |
CareNeeds PLUS (HMO SNP)
|
$13.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$17.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$88.00 | $176.00 | Q:31 /31Days | $120.43 |
Browse Plan Formulary |
Advantage by Sunshine Health (HMO SNP)
|
$21.00 |
$310 | Many Generics | 2 |
Preferred Brand |
$45.00 | $45.00 | Q:30 /30Days | $119.91 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$22.00 |
$310 | Many Generics, Few Brands | 2 |
Preferred Brand |
$0.00 | $0.00 | Q:30 /30Days | $117.48 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$22.10 |
$310 | Some Generics | 3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $117.48 |
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 |
Freedom Medi-Medi Full (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | S Q:30 /30Days | $120.45 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $120.45 |
Browse Plan Formulary |
MediMax (HMO)
|
$22.10 |
$310 | Call plan for details | 4 |
Non-Preferred Brand |
25% | n/a | None | $117.74 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | S Q:30 /30Days | $120.51 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $120.51 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$22.10 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$25.00 | n/a | None | $115.95 |
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 |
Simply Comfort (HMO SNP)
|
$22.10 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$25.00 | n/a | None | $115.95 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$22.10 |
$310 | Many Generics | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $115.95 |
Browse Plan Formulary |
Touch Institutional Special Needs Plan (HMO SNP)
|
$22.10 |
$310 | Some Generics | 3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$35.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $90.00 | Q:1 /1Days | $118.84 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$36.60 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $110.00 | Q:30 /30Days | $116.69 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$45.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.79 |
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 |
Humana Gold Choice H8145-061 (PFFS)
|
$103.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $116.72 |
Browse Plan Formulary |