ABILIFY 20MG TABLET (30 BOT) (NDC: 59148001013)
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 | $1,147.28 |
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 | $1,146.40 |
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 | $1,147.91 |
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 | $1,146.11 |
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 | $1,149.09 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$42.00 | $105.00 | S Q:30 /30Days | $1,122.68 |
Browse Plan Formulary |
Meridian Prime (HMO)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$85.00 | $255.00 | None | $1,125.63 |
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 | $1,149.09 |
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 | $1,146.42 |
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 | $1,148.68 |
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 | $1,145.95 |
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 | $1,146.93 |
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 | $1,107.61 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$32.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,121.02 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:180 /90Days | $1,124.58 |
Browse Plan Formulary |
Fidelis Secure Freedom (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:180 /90Days | $1,124.58 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | S Q:30 /30Days | $1,122.62 |
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 | 4 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,133.24 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $1,125.63 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantagePPO Basic (PPO)
|
$48.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | S Q:30 /30Days | $1,121.25 |
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 | $1,183.35 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$60.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,137.33 |
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 | $1,146.93 |
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 | $1,145.95 |
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 | $1,148.68 |
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 | $1,146.42 |
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 | $1,149.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S | $1,149.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S | $1,147.28 |
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)
|
$95.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S | $1,146.40 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S | $1,147.91 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$95.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | S | $1,146.11 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | S Q:30 /30Days | $1,122.68 |
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 | $1,183.35 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,135.70 |
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)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,137.23 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,137.33 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,136.06 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,136.88 |
Browse Plan Formulary |
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 | $1,183.35 |
Browse Plan Formulary |
McLarenAdvantage (HMO)
|
$128.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,133.24 |
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 (HMO-POS)
|
$138.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,137.33 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,149.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,146.42 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,146.93 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,148.68 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $1,145.95 |
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 | 2 |
Preferred Brand |
$38.00 | $95.00 | S Q:30 /30Days | $1,122.68 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,135.70 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,137.23 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,137.33 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,136.06 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,136.88 |
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 AdvantagePPO Enhanced (PPO)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | S Q:30 /30Days | $1,121.25 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$179.00 |
$50 | All Generics | 4 |
Non-Preferred Brand |
31% | 31% | P Q:30 /30Days | $1,183.35 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$203.00 |
$150 | All Generics | 4 |
Non-Preferred Brand |
29% | 29% | P Q:30 /30Days | $1,183.35 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $1,149.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $1,146.93 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $1,145.95 |
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 | $1,148.68 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$222.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $1,146.42 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | S | $1,147.28 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | S | $1,146.40 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | S | $1,147.91 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | S | $1,146.11 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$228.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | S | $1,149.09 |
Browse Plan Formulary |