FazaClo 25mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE (100 TABLET, ORALLY DISINT ) (NDC: 18860010210)
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 SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $297.23 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $297.23 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | Few Generics | 3 |
Non-Preferred Brand |
50% | 50% | S Q:3 /1Days | $295.68 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$90.00 | $270.00 | Q:1080 /30Days | $298.64 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$85.00 | $170.00 | None | $293.04 |
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 |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$70.00 | $140.00 | None | $293.04 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:1080 /30Days | $304.33 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$310 | Many Generics | 4 |
Non-Preferred Brand |
25% | 25% | Q:1080 /30Days | $304.21 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:1080 /30Days | $304.33 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:1080 /30Days | $304.33 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:1080 /30Days | $304.33 |
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 |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:1080 /30Days | $304.35 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:1080 /30Days | $304.33 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:1080 /30Days | $303.58 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | Q:270 /30Days | $303.58 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$75.00 | $150.00 | None | $301.69 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $296.50 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $238.00 | None | $293.48 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $238.00 | None | $293.38 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $293.48 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $293.38 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $293.39 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $293.48 |
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 |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $293.38 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $298.64 |
Browse Plan Formulary |
Humana Gold Plus H0108-011 (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | S | $290.63 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$79.00 | $158.00 | Q:270 /30Days | $303.58 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $90.00 | None | $321.08 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $298.64 |
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 |
SCAN Classic (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$85.00 | $170.00 | None | $299.57 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$85.00 | $170.00 | None | $298.11 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$4.00 |
$0 | to be determined | 3 |
Preferred Brand |
$45.00 | $90.00 | None | $320.51 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$14.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | None | $320.51 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$16.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $296.53 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$21.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $294.25 |
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 |
SCAN Connections (HMO SNP)
|
$24.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | None | $299.57 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$28.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $298.56 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$28.10 |
$310 | Many Generics | 4 |
Non-Preferred Brand |
25% | 25% | Q:270 /30Days | $303.58 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$28.10 |
$310 | Many Generics | 4 |
Non-Preferred Brand |
25% | 25% | Q:270 /30Days | $303.58 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $293.39 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $293.43 |
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 |
SCAN Connections at Home (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | None | $299.57 |
Browse Plan Formulary |
VillageHealth (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $298.64 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$30.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:270 /30Days | $303.58 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$80.00 |
$149 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$85.00 | $255.00 | Q:1080 /30Days | $299.57 |
Browse Plan Formulary |