ABSTRAL 800 MCG TAB SUBLINGUAL (NDC: 57881033804)
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 | 5 |
Tier 5 |
25% | 25% | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:136 /34Days | $2,747.05 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | 25% | P Q:120 /30Days | $2,730.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
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 |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | P Q:120 /30Days | $2,730.71 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
|
$48.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | 25% | P Q:120 /30Days | $2,730.71 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$54.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
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 |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
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)
|
$74.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | P Q:120 /30Days | $2,730.71 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$123.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
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 |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P | $2,675.33 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P Q:120 /30Days | $2,730.71 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | P Q:120 /30Days | $2,730.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
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)
|
$222.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:124 /31Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:136 /34Days | $2,747.05 |
Browse Plan Formulary |