ABILIFY 5MG TABLET (OTSUKA) (30 BOT) (NDC: 59148000713)
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% | S | $809.66 |
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% | S | $811.46 |
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% | S | $810.44 |
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% | S | $811.71 |
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% | S | $809.52 |
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% | None | $808.80 |
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% | None | $811.46 |
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% | None | $810.49 |
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% | None | $811.94 |
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% | None | $809.25 |
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 | $783.96 |
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 |
McLarenAdvantage (HMO SNP)
|
$32.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days | $802.27 |
Browse Plan Formulary |
Paramount Elite - Standard Medical and Drug (HMO)
|
$34.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $80.00 | Q:540 /90Days | $810.30 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$54.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:31 /31Days | $804.85 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
33% | 33% | P Q:30 /30Days | $837.90 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:31 /31Days | $804.42 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:31 /31Days | $804.84 |
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 |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:31 /31Days | $804.66 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:31 /31Days | $804.85 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$61.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:31 /31Days | $804.79 |
Browse Plan Formulary |
HumanaChoice H5216-009 (PPO)
|
$65.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $785.50 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $809.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $808.80 |
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 |
3 |
Tier 3 |
25% | 25% | None | $811.46 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $810.49 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$74.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $811.94 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$80.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $784.95 |
Browse Plan Formulary |
Paramount Elite - Enhanced Medical and Drug (HMO)
|
$93.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $80.00 | Q:540 /90Days | $810.30 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$99.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
30% | 30% | P Q:30 /30Days | $837.90 |
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)
|
$105.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $811.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$105.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $809.52 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$105.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $811.46 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$105.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $809.66 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$105.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $810.44 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$123.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:31 /31Days | $804.85 |
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 |
Alliance Medicare PPO (PPO)
|
$124.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
33% | 33% | P Q:30 /30Days | $837.90 |
Browse Plan Formulary |
McLarenAdvantage (HMO)
|
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$70.00 | $140.00 | Q:30 /30Days | $802.27 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:31 /31Days | $804.85 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:31 /31Days | $804.79 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:31 /31Days | $804.42 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:31 /31Days | $804.84 |
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 |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:31 /31Days | $804.66 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $811.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $809.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $808.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $811.46 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $810.49 |
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 |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$179.00 |
$50 |
All Generics |
4 |
Non-Preferred Brand |
31% | 31% | P Q:30 /30Days | $837.90 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$203.00 |
$150 |
All Generics |
4 |
Non-Preferred Brand |
29% | 29% | P Q:30 /30Days | $837.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $810.49 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $811.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $809.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $808.80 |
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 |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $811.46 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $809.52 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $809.66 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $811.46 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $810.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$246.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $811.71 |
Browse Plan Formulary |