ABILIFY 15MG TABLET (30 BOT) (NDC: 59148000913)
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 |
AHM Classic (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | None | $809.23 |
Browse Plan Formulary |
AHM Classic Plus (HMO SNP)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | None | $809.23 |
Browse Plan Formulary |
AHM Platino Plus (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $809.23 |
Browse Plan Formulary |
AHM Standard (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | None | $809.23 |
Browse Plan Formulary |
Apollo - Constellation Health (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $837.17 |
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 |
First Care+Plus (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | None | $816.32 |
Browse Plan Formulary |
First+Plus Advantage Plus (PPO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$55.00 | $110.00 | None | $816.32 |
Browse Plan Formulary |
First+Plus Complete (HMO SNP)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | None | $816.32 |
Browse Plan Formulary |
First+Plus Platino (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $816.32 |
Browse Plan Formulary |
First+Plus Smart Premium (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$55.00 | $110.00 | None | $816.32 |
Browse Plan Formulary |
First+Plus Smart Value (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$65.00 | $130.00 | None | $816.32 |
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 |
Genesis - Constellation Health (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $837.17 |
Browse Plan Formulary |
Humana Gold Plus H4007-012 (HMO)
|
$0.00 |
$310* | Few Generics, Few Brands | 3* |
Non-Preferred Brand |
$30.00 | $80.00 | Q:30 /30Days | $841.49 |
Browse Plan Formulary |
Humana Gold Plus H4007-013 (HMO)
|
$0.00 |
$0 | Few Generics | 2 |
Preferred Brand |
$25.00 | $65.00 | Q:30 /30Days | $841.49 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4007-005 (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $841.49 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4007-016 (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $841.49 |
Browse Plan Formulary |
MCS Classicare B-Max (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | S Q:30 /30Days | $850.33 |
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 |
MCS Classicare Essential (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | S Q:30 /30Days | $850.33 |
Browse Plan Formulary |
MCS Classicare InteliCare (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | S Q:30 /30Days | $850.33 |
Browse Plan Formulary |
MCS Classicare Platino Ideal (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | S Q:30 /30Days | $850.33 |
Browse Plan Formulary |
MCS Classicare Platino M
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | S Q:30 /30Days | $850.33 |
Browse Plan Formulary |
MCS Classicare Platino Superior (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | S Q:30 /30Days | $850.33 |
Browse Plan Formulary |
MCS Classicare Premium Health (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | S Q:30 /30Days | $850.33 |
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 |
Medicare y Mucho Mas - BASICO EXTRA (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | S | $837.39 |
Browse Plan Formulary |
Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | S | $837.39 |
Browse Plan Formulary |
Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | S | $837.39 |
Browse Plan Formulary |
Medicare y Mucho Mas - ELITE ULTRA (HMO-POS)
|
$0.00 |
$0 | Some Generics | 2 |
Preferred Brand |
$40.00 | $80.00 | S | $837.39 |
Browse Plan Formulary |
Medicare y Mucho Mas - UNICO EXTRA (HMO)
|
$0.00 |
$0 | Some Generics | 2 |
Preferred Brand |
$40.00 | $80.00 | S | $837.39 |
Browse Plan Formulary |
PMC Max - EXTRA (HMO-POS)
|
$0.00 |
$0 | Some Generics | 2 |
Preferred Brand |
$40.00 | $80.00 | S | $837.39 |
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 |
Premier Preferred (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | S | $837.39 |
Browse Plan Formulary |
Triple-S Medicare Optimo Select (HMO) (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
25% | 25% | None | $809.23 |
Browse Plan Formulary |
Triple-S Medicare Selecto with Medicare Platino (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $809.23 |
Browse Plan Formulary |
PMC Max (HMO)
|
$10.00 |
$0 | Some Generics | 2 |
Preferred Brand |
$35.00 | $70.00 | S | $837.39 |
Browse Plan Formulary |
Medicare y Mucho Mas - Unico (HMO)
|
$25.00 |
$0 | Some Generics | 2 |
Preferred Brand |
$30.00 | $60.00 | S | $837.39 |
Browse Plan Formulary |
Triple-S Medicare Optimo Premier (HMO)
|
$27.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
25% | 25% | None | $809.23 |
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 |
AHM Opal (HMO-POS)
|
$33.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$70.00 | $140.00 | None | $809.23 |
Browse Plan Formulary |
Medicare y Mucho Mas - ELITE (HMO-POS)
|
$33.50 |
$0 | Some Generics | 2 |
Preferred Brand |
$20.00 | $40.00 | S | $837.39 |
Browse Plan Formulary |
Medicare y Mucho Mas - SUPREMO (HMO SNP)
|
$34.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$45.00 | $90.00 | S | $837.39 |
Browse Plan Formulary |
Elite Dorado (HMO-POS)
|
$34.50 |
$0 | Some Generics | 2 |
Preferred Brand |
$29.00 | $58.00 | S | $837.39 |
Browse Plan Formulary |
HumanaChoice H2029-001 (PPO)
|
$45.00 |
$0 | Some Generics, Few Brands | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | Q:30 /30Days | $841.49 |
Browse Plan Formulary |
Olympus - Constellation Health (PPO)
|
$51.00 |
$0 | Many Generics, Few Brands | 2 |
Preferred Brand |
$25.00 | $75.00 | Q:30 /30Days | $837.17 |
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 |
Alpha - Constellation Health (HMO SNP)
|
$62.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days | $837.17 |
Browse Plan Formulary |
Triple-S Medicare Optimo Plus (PPO)
|
$73.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
25% | 25% | None | $809.23 |
Browse Plan Formulary |
Medicare y Mucho Mas - ELITE EXTRA (HMO-POS)
|
$76.30 |
$0 | Some Generics | 3 |
Preferred Brand |
$25.00 | $50.00 | None | $837.39 |
Browse Plan Formulary |
MCS Classicare Advanced Health (HMO-POS)
|
$79.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$34.00 | $34.00 | S Q:30 /30Days | $850.33 |
Browse Plan Formulary |
HumanaChoice H2029-002 (PPO)
|
$103.00 |
$0 | Some Generics, Few Brands | 4 |
Non-Preferred Brand |
$68.00 | $194.00 | Q:30 /30Days | $841.49 |
Browse Plan Formulary |