ACEBUTOLOL 200MG CAPSULE (100 BOT) (NDC: 00378120001)
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 | 2 |
Tier 2 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $7.94 |
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 | 1 |
Generic |
$10.00 | $20.00 | None | $9.22 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $17.50 | None | $11.41 |
Browse Plan Formulary |
Meridian Prime (HMO)
|
$0.00 |
$310* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $16.68 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
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 | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$27.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | None | $11.11 |
Browse Plan Formulary |
HumanaChoice R5826-006 P (Regional PPO)
|
$30.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $6.29 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$32.40 |
$310* | No additional gap coverage, only the Donut Hole Discount | 1* |
Generic |
$0.00 | $0.00 | None | $6.38 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $9.24 |
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 Freedom (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $9.24 |
Browse Plan Formulary |
Fidelis Secure Liberty (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $9.22 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $11.37 |
Browse Plan Formulary |
McLarenAdvantage (HMO SNP)
|
$32.50 |
$310* | No additional gap coverage, only the Donut Hole Discount | 1* |
Generic |
$0.00 | $0.00 | None | $7.75 |
Browse Plan Formulary |
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 | None | $16.68 |
Browse Plan Formulary |
Midwest Advantage (HMO SNP)
|
$32.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$0.00 | n/a | None | $7.75 |
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 |
Total Medicare Plus (HMO SNP)
|
$32.50 |
$310* | Many Generics | 1* |
Preferred Generic |
$0.00 | n/a | None | $11.42 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
|
$48.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $17.50 | None | $11.14 |
Browse Plan Formulary |
Fidelis Secure Premier (HMO)
|
$52.00 |
$0 | Many Generics | 1 |
Generic |
$5.00 | $10.00 | None | $9.22 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$58.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $8.24 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$60.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $7.88 |
Browse Plan Formulary |
BCN Advantage HMO Local (HMO)
|
$66.00 |
$50 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
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 |
HAP Senior Plus - Henry Ford (HMO)
|
$73.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$15.00 | $37.50 | None | $8.26 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $17.50 | None | $11.41 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$99.00 |
$100* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$15.00 | $37.50 | None | $8.24 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
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 | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$99.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $7.94 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $7.88 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $7.88 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $7.88 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $7.88 |
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 | 1 |
Generic |
$10.00 | $25.00 | None | $7.88 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$124.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | None | $8.24 |
Browse Plan Formulary |
McLarenAdvantage (HMO)
|
$128.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
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 | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$138.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $7.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
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 | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$148.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 | Many Generics | 1 |
Generic |
$6.00 | $15.00 | None | $11.41 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $7.88 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $7.88 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $7.88 |
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 | 1 |
Generic |
$8.00 | $20.00 | None | $7.88 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $7.88 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$6.00 | $15.00 | None | $11.14 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$179.00 |
$50* | All Generics | 2* |
Non-Preferred Generic |
$10.00 | $25.00 | None | $8.24 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$203.00 |
$150* | All Generics | 2* |
Non-Preferred Generic |
$10.00 | $25.00 | None | $8.24 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
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 | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
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 | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $7.94 |
Browse Plan Formulary |