GABAPENTIN 400 MG CAPSULE (100 EA ) (NDC: 53746010301)
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 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$9.00 | $18.00 | None | $11.43 |
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Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics |
1 |
Generic |
$10.00 | $20.00 | None | $23.40 |
Browse Plan Formulary |
Blue Medicare Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for Blue Medicare Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics |
2 |
Non-Preferred Generic |
$14.00 | $42.00 | None | $14.57 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Breathe (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:270 /30Days | $11.11 |
Browse Plan Formulary |
CareMore Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:270 /30Days | $11.11 |
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 Heart (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:270 /30Days | $11.11 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for CareMore StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $20.00 | Q:270 /30Days | $11.11 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
![Email Prescription and/or Health Benefit details for CareMore Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:270 /30Days | $11.11 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Diabetes Heart (HMO SNP)
![Email Prescription and/or Health Benefit details for Cigna Medicare Select Plus Rx-Diabetes Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$9.00 | $18.00 | None | $21.75 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Standard (HMO)
![Email Prescription and/or Health Benefit details for Cigna Medicare Select Plus Rx-Standard (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $21.75 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $14.69 |
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 Jade Cardiovascular (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade Cardiovascular (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $14.69 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby 4 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $14.28 |
Browse Plan Formulary |
Health Net Ruby Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $14.28 |
Browse Plan Formulary |
Heart First (HMO SNP)
![Email Prescription and/or Health Benefit details for Heart First (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $32.47 |
Browse Plan Formulary |
Humana Gold Plus H2649-032 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H2649-032 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | Q:270 /30Days | $11.09 |
Browse Plan Formulary |
Humana Gold Plus SNP-CLD H2649-037 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-CLD H2649-037 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | Q:270 /30Days | $11.09 |
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-CVD/CHF/DM H2649-036 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-CVD/CHF/DM H2649-036 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | Q:270 /30Days | $11.09 |
Browse Plan Formulary |
Phoenix Advantage (HMO)
![Email Prescription and/or Health Benefit details for Phoenix Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $30.65 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Balance (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $32.47 |
Browse Plan Formulary |
SCAN Classic (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $32.47 |
Browse Plan Formulary |
Blue Medicare Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Medicare Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.00 |
$0 |
Few Generics |
2 |
Non-Preferred Generic |
$13.00 | $39.00 | None | $14.57 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $11.39 |
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 |
ONECare by Care1st Health Plan Arizona, Inc. (HMO SNP)
![Email Prescription and/or Health Benefit details for ONECare by Care1st Health Plan Arizona, Inc. (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.70 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
25% | n/a | None | $20.20 |
Browse Plan Formulary |
Advantage by Bridgeway Health Solutions (HMO SNP)
![Email Prescription and/or Health Benefit details for Advantage by Bridgeway Health Solutions (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $28.48 |
Browse Plan Formulary |
Health Choice Generations (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Choice Generations (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $11.99 |
Browse Plan Formulary |
Health Net Amber (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Amber (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $14.31 |
Browse Plan Formulary |
Maricopa Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Maricopa Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $18.99 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Mercy Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $23.64 |
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 |
Mercy Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Mercy Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $23.65 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Mercy Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $23.65 |
Browse Plan Formulary |
Phoenix Advantage Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Phoenix Advantage Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $30.83 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $11.40 |
Browse Plan Formulary |
HumanaChoice R5826-014 P (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-014 P (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$175* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$12.00 | $0.00 | Q:270 /30Days | $11.09 |
Browse Plan Formulary |
Phoenix Advantage Select (HMO)
![Email Prescription and/or Health Benefit details for Phoenix Advantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $30.65 |
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 Ruby 1 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $14.28 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $13.86 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $15.91 |
Browse Plan Formulary |
Blue Medicare Advantage Premier (HMO)
![Email Prescription and/or Health Benefit details for Blue Medicare Advantage Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.00 |
$0 |
Few Generics |
2 |
Non-Preferred Generic |
$12.00 | $36.00 | None | $14.57 |
Browse Plan Formulary |
Humana Gold Plus H2649-030 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H2649-030 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$79.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | Q:270 /30Days | $11.09 |
Browse Plan Formulary |
HumanaChoice H0317-001 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H0317-001 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$122.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | Q:270 /30Days | $11.09 |
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 Choice H8145-103 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-103 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$180.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | Q:270 /30Days | $11.09 |
Browse Plan Formulary |