ELIDEL 1% CREAM (100 GM ) (NDC: 00187510203)
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 |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | S | $739.79 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
Few Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | S | $741.15 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Few Generics |
3 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:2 /1Days | $738.38 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $735.17 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $105.00 | P | $750.52 |
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 |
BlueMedicare HMO LifeTime (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S | $738.40 |
Browse Plan Formulary |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S | $738.40 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$30 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S | $737.91 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Brand |
$50.00 | $140.00 | None | $731.52 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $731.52 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Brand |
$50.00 | $140.00 | None | $731.52 |
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 |
CareOne (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Brand |
$50.00 | $140.00 | None | $731.52 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$10.00 | $30.00 | P Q:30 /30Days | $758.23 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$45.00 | $135.00 | S Q:30 /30Days | $747.76 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$75.00 | $225.00 | S Q:30 /30Days | $747.76 |
Browse Plan Formulary |
Day Break (HMO)
|
$0.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$20.00 | $60.00 | P Q:30 /30Days | $758.23 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$30.00 | $60.00 | S | $721.17 |
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 (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$30.00 | $60.00 | S | $720.49 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$30.00 | $60.00 | S | $720.51 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
33% | n/a | None | $730.47 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Brand |
$50.00 | $140.00 | None | $731.52 |
Browse Plan Formulary |
Humana Gold Plus H1036-224 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $731.52 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Brand |
$50.00 | $140.00 | None | $731.52 |
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 |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Brand |
$50.00 | $140.00 | None | $731.52 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$150 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $728.49 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$89.00 | n/a | S | $741.15 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$30.00 | $60.00 | S | $721.02 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$5.00 | $10.00 | S | $721.02 |
Browse Plan Formulary |
Preferred Choice Broward (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$40.00 | $110.00 | S | $741.15 |
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 Clear (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
25% | n/a | S | $723.69 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$75.00 | n/a | S | $722.73 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
4 |
Non-Preferred Brand |
$30.00 | n/a | S | $722.73 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$30.00 | n/a | S | $722.73 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$40.00 | n/a | S | $722.73 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$0.00 | n/a | None | $730.47 |
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 |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$0.00 | n/a | None | $730.47 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$10.00 | $30.00 | P Q:30 /30Days | $758.23 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-185 (HMO SNP)
|
$7.70 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $731.52 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$8.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $731.52 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$9.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$88.00 | $176.00 | P | $752.26 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$10.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$84.00 | $168.00 | P | $752.26 |
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 |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
|
$10.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $731.52 |
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 | P | $751.95 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$11.70 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $731.52 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$17.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $731.52 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$18.90 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$76.00 | $228.00 | S Q:30 /30Days | $746.08 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$19.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $740.14 |
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 |
Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)
|
$20.60 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
25% | n/a | S | $739.80 |
Browse Plan Formulary |
Advantage by Sunshine Health (HMO SNP)
|
$21.00 |
$310 |
Many Generics |
3 |
Non-Preferred Brand |
$95.00 | $95.00 | P Q:60 /30Days | $746.09 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$21.20 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
25% | 25% | S | $739.80 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$21.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | S | $739.79 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$22.00 |
$310 |
Many Generics, Few Brands |
3 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $735.16 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
4 |
Non-Preferred Brand |
25% | 25% | P | $735.17 |
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 |
Coventry Vista Maximum Choice (HMO SNP)
|
$22.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$76.00 | $228.00 | S Q:30 /30Days | $745.75 |
Browse Plan Formulary |
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 | $721.49 |
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 | $721.49 |
Browse Plan Formulary |
MediMax (HMO)
|
$22.10 |
$310 |
Call plan for details |
4 |
Non-Preferred Brand |
25% | n/a | None | $727.00 |
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 | $721.43 |
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 | $721.43 |
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 |
Simply Care (HMO SNP)
|
$22.10 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$25.00 | n/a | S | $722.71 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$22.10 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$25.00 | n/a | S | $722.71 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$22.10 |
$310 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | n/a | S | $722.73 |
Browse Plan Formulary |
Touch Institutional Special Needs Plan (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
4 |
Non-Preferred Brand |
25% | 25% | P | $735.19 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$33.90 |
$0 |
All Generics |
2 |
Preferred Brand |
25% | 25% | P Q:30 /30Days | $758.23 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$35.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:2 /1Days | $738.38 |
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 R5826-005 (Regional PPO)
|
$36.60 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | None | $728.49 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$45.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | None | $728.78 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$103.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $728.68 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$127.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | $225.00 | S | $738.73 |
Browse Plan Formulary |