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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $121.96 |
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% | None | $119.50 |
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% | None | $119.81 |
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% | None | $119.43 |
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% | None | $120.35 |
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 |
Fidelis Secure Respect (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $117.97 |
Browse Plan Formulary |
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 | S | $119.95 |
Browse Plan Formulary |
Meridian Prime (HMO)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$85.00 | $255.00 | S | $119.01 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $121.96 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $119.50 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $119.70 |
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 |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $120.41 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $119.86 |
Browse Plan Formulary |
HumanaChoice R5826-006 P (Regional PPO)
|
$30.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $115.98 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$32.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days | $117.63 |
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 | S | $119.95 |
Browse Plan Formulary |
McLarenAdvantage (HMO SNP)
|
$32.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days | $119.71 |
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 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 | S | $119.01 |
Browse Plan Formulary |
Total Medicare Plus (HMO SNP)
|
$32.50 |
$310 |
Many Generics |
4 |
Non-Preferred Brand |
25% | n/a | None | $122.54 |
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 | S | $119.71 |
Browse Plan Formulary |
Fidelis Secure Premier (HMO)
|
$52.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $117.97 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
33% | 33% | P | $125.44 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$60.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | S | $120.49 |
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 Local (HMO)
|
$66.00 |
$50 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $119.31 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$73.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
27% | 27% | P | $125.49 |
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 | S | $119.95 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$99.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
30% | 30% | P | $125.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $119.86 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $121.96 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $119.50 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $119.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:90 /90Days | $120.41 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | S | $119.42 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | S | $120.49 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | S | $120.44 |
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 |
2 |
Preferred Brand |
$45.00 | $112.50 | S | $120.22 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | S | $119.66 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$124.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
33% | 33% | P | $125.44 |
Browse Plan Formulary |
McLarenAdvantage (HMO)
|
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$30.00 | $60.00 | Q:30 /30Days | $119.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $119.43 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $120.35 |
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)
|
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $121.96 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $119.50 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $119.81 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$138.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | S | $120.49 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:90 /90Days | $120.41 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:90 /90Days | $119.86 |
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)
|
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:90 /90Days | $119.50 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:90 /90Days | $121.96 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:90 /90Days | $119.70 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $119.95 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | S | $120.22 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | S | $119.66 |
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)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | S | $119.42 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | S | $120.49 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | S | $120.44 |
Browse Plan Formulary |
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 | S | $119.71 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$179.00 |
$50 |
All Generics |
4 |
Non-Preferred Brand |
31% | 31% | P | $125.44 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$203.00 |
$150 |
All Generics |
4 |
Non-Preferred Brand |
29% | 29% | P | $125.44 |
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)
|
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $120.35 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $121.96 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $119.50 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $119.81 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $119.43 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:90 /90Days | $119.70 |
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)
|
$272.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:90 /90Days | $120.41 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:90 /90Days | $119.86 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:90 /90Days | $121.96 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:90 /90Days | $119.50 |
Browse Plan Formulary |