ACUVAIL 0.45% OPHTH SOLUTION #30X0.4 EA (#30X0.4 ) (NDC: 00023350730)
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)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.98 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.85 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.65 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.55 |
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)
![Email Prescription and/or Health Benefit details for Fidelis Secure Respect (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $200.14 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $201.83 |
Browse Plan Formulary |
Meridian Prime (HMO)
![Email Prescription and/or Health Benefit details for Meridian Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$85.00 | $255.00 | None | $201.79 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.77 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $203.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.55 |
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)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.97 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.85 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
n/a | n/a | None | $202.37 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
![Email Prescription and/or Health Benefit details for Meridian Advantage Plan of Michigan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $201.79 |
Browse Plan Formulary |
Total Medicare Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Total Medicare Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.50 |
$310 |
Many Generics |
4 |
Non-Preferred Brand |
25% | n/a | None | $207.72 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus AdvantagePPO Basic (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $201.75 |
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 Premier (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $200.14 |
Browse Plan Formulary |
BCN Advantage HMO Local (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO Local (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$66.00 |
$50 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $202.25 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $201.83 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.77 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $203.10 |
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)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $202.97 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $202.65 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $202.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $202.55 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $202.98 |
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)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$130.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $202.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.97 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.77 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $203.10 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$150.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $201.83 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$176.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $201.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $202.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $202.55 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $202.98 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $202.85 |
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)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$246.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $202.65 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$272.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $203.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$272.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$272.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.97 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$272.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$272.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $202.77 |
Browse Plan Formulary |