Actonel 30mg/1 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE (12 BOTTLE in 1 CASE / 30 ) (NDC: 00430047015)
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 | 3 |
Tier 3 |
25% | 25% | Q:34 /34Days | $1,545.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:34 /34Days | $1,545.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:34 /34Days | $1,551.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:34 /34Days | $1,545.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:34 /34Days | $1,568.91 |
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 | 2 |
Preferred Brand |
$45.00 | $90.00 | S Q:90 /90Days | $1,535.84 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days | $1,543.55 |
Browse Plan Formulary |
Meridian Prime (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | S | $1,537.72 |
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% | S Q:90 /90Days | $1,545.59 |
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% | S Q:90 /90Days | $1,568.91 |
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% | S Q:90 /90Days | $1,545.59 |
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% | S Q:90 /90Days | $1,545.59 |
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% | S Q:90 /90Days | $1,551.88 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$27.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | None | $1,520.91 |
Browse Plan Formulary |
HumanaChoice R5826-006 P (Regional PPO)
|
$30.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:30 /30Days | $1,506.22 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | Q:30 /30Days | $1,546.10 |
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 | S | $1,537.72 |
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 |
Midwest Advantage (HMO SNP)
|
$32.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Brand |
$0.00 | n/a | Q:30 /30Days | $1,543.03 |
Browse Plan Formulary |
Total Medicare Plus (HMO SNP)
|
$32.50 |
$310 | Many Generics | 4 |
Non-Preferred Brand |
25% | n/a | S | $1,487.57 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
|
$48.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | Q:30 /30Days | $1,541.15 |
Browse Plan Formulary |
Fidelis Secure Premier (HMO)
|
$52.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$40.00 | $80.00 | S Q:90 /90Days | $1,535.84 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$58.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | S Q:4 /28Days | $1,544.45 |
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 | Q:31 /31Days | $1,550.53 |
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 |
BCN Advantage HMO Local (HMO)
|
$66.00 |
$50 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:34 /34Days | $1,549.52 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$73.00 |
$200 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | S Q:4 /28Days | $1,543.31 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | Q:30 /30Days | $1,543.55 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$99.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | S Q:4 /28Days | $1,544.45 |
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% | S Q:90 /90Days | $1,545.59 |
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% | S Q:90 /90Days | $1,568.91 |
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% | S Q:90 /90Days | $1,545.59 |
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% | S Q:90 /90Days | $1,545.59 |
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% | S Q:90 /90Days | $1,551.88 |
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 | Q:31 /31Days | $1,555.16 |
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 | Q:31 /31Days | $1,547.42 |
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 | Q:31 /31Days | $1,546.36 |
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 | Q:31 /31Days | $1,553.17 |
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 | Q:31 /31Days | $1,550.53 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$124.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | S Q:4 /28Days | $1,544.45 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $1,545.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $1,551.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $1,545.59 |
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 | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $1,545.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$130.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $1,568.91 |
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 | Q:31 /31Days | $1,550.53 |
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 | S Q:90 /90Days | $1,545.59 |
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 | S Q:90 /90Days | $1,568.91 |
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 | S Q:90 /90Days | $1,545.59 |
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 | S Q:90 /90Days | $1,545.59 |
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 | S Q:90 /90Days | $1,551.88 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$38.00 | $95.00 | Q:30 /30Days | $1,543.55 |
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 | Q:31 /31Days | $1,547.42 |
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 | Q:31 /31Days | $1,555.16 |
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 | Q:31 /31Days | $1,546.36 |
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 | Q:31 /31Days | $1,553.17 |
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 | Q:31 /31Days | $1,550.53 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | Q:30 /30Days | $1,541.15 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$179.00 |
$50 | All Generics | 3 |
Preferred Brand |
$45.00 | $112.50 | S Q:4 /28Days | $1,544.45 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$203.00 |
$150 | All Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S Q:4 /28Days | $1,544.45 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $1,545.59 |
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 | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $1,545.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $1,568.91 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $1,551.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $1,545.59 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S Q:90 /90Days | $1,545.59 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S Q:90 /90Days | $1,568.91 |
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 | S Q:90 /90Days | $1,545.59 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S Q:90 /90Days | $1,545.59 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$272.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S Q:90 /90Days | $1,551.88 |
Browse Plan Formulary |