HYDROCORTISONE 5MG TABLET (50 BOT) (NDC: 00603389919)
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 |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $14.72 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Few Generics |
1 |
Generic |
$10.00 | $20.00 | None | $15.27 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $15.02 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $15.00 |
Browse Plan Formulary |
AvMed Medicare Choice Elect (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$4.00 | $0.00 | None | $15.00 |
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 |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $16.74 |
Browse Plan Formulary |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $16.74 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$30 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $99.00 | None | $16.74 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
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 PLUS (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $16.24 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $18.00 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $18.00 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $18.00 |
Browse Plan Formulary |
Day Break (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $16.24 |
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 |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $16.59 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-188 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$150* |
Few Generics, Few Brands |
2* |
Non-Preferred Generic |
$15.00 | $0.00 | None | $22.57 |
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 |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$0.00 | n/a | None | $16.18 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $14.59 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | n/a | None | $18.07 |
Browse Plan Formulary |
Preferred Choice Dade (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $14.59 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
|
$0.00 |
$0 |
Many Generics, Some Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $14.59 |
Browse Plan Formulary |
Preferred Medical Plan Choice (HMO)
|
$0.00 |
$0 |
Many Generics, Many Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $18.26 |
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 |
Preferred Medical Plan Value (HMO)
|
$0.00 |
$0 |
Some Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $18.26 |
Browse Plan Formulary |
Preferred Special Care Miami-Dade (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $14.59 |
Browse Plan Formulary |
Simply Clear (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
25% | n/a | None | $16.77 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.77 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.77 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.77 |
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 Options (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.77 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
1 |
Preferred Generic |
$0.00 | n/a | None | $16.59 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
1 |
Preferred Generic |
$0.00 | n/a | None | $16.59 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $16.24 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$3.60 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $16.24 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-187 (HMO SNP)
|
$7.80 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
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 |
WellCare Select (HMO SNP)
|
$11.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $17.89 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$11.80 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$12.10 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $17.88 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$13.60 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$17.50 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $22.67 |
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 |
WellCare Liberty (HMO SNP)
|
$17.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $17.88 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$18.90 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $17.98 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$19.90 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $14.56 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)
|
$20.60 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $14.83 |
Browse Plan Formulary |
Advantage by Sunshine Health (HMO SNP)
|
$21.00 |
$310* |
Many Generics |
1* |
Generic |
$0.00 | $0.00 | None | $17.55 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$21.20 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $14.83 |
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 |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$21.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $14.72 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$22.00 |
$310* |
Many Generics, Few Brands |
1* |
Generic |
$0.00 | $0.00 | None | $15.71 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $15.02 |
Browse Plan Formulary |
Coventry Vista Maximum (HMO SNP)
|
$22.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $17.98 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$22.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $17.98 |
Browse Plan Formulary |
MediMax (HMO)
|
$22.10 |
$310 |
Call plan for details |
1 |
Preferred Generic |
25% | n/a | None | $16.73 |
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 |
1 |
Preferred Generic |
$0.00 | n/a | None | $16.77 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$22.10 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $16.77 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$22.10 |
$310* |
Many Generics |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $16.77 |
Browse Plan Formulary |
Touch Institutional Special Needs Plan (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $15.02 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$35.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$4.00 | $8.00 | None | $15.32 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$36.60 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$8.00 | $0.00 | None | $22.57 |
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 H5415-056 (PPO)
|
$45.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $22.55 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$103.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$15.00 | $0.00 | None | $22.57 |
Browse Plan Formulary |