PROAIR HFA 90 MCG INHALER (NDC: 59310057922)
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)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $49.53 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
Few Generics |
2 |
Preferred Brand |
25% | 25% | None | $50.27 |
Browse Plan Formulary |
Blue Medicare Advantage Classic (HMO)
|
$0.00 |
$0 |
Few Generics |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:23 /30Days | $49.30 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:18 /30Days | $51.43 |
Browse Plan Formulary |
CareMore Diabetes (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:18 /30Days | $51.43 |
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)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:18 /30Days | $51.43 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:18 /30Days | $51.43 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:18 /30Days | $51.43 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Diabetes Heart (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $80.00 | None | $47.64 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Standard (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $80.00 | None | $47.64 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$44.00 | $122.00 | None | $49.04 |
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)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$44.00 | $122.00 | None | $49.04 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $49.06 |
Browse Plan Formulary |
Health Net Ruby Select (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$44.00 | $122.00 | None | $49.06 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:26 /31Days | $49.31 |
Browse Plan Formulary |
Humana Gold Plus H2649-032 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:36 /30Days | $48.81 |
Browse Plan Formulary |
Humana Gold Plus SNP-CLD H2649-037 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:36 /30Days | $48.81 |
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)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:36 /30Days | $48.81 |
Browse Plan Formulary |
Phoenix Advantage (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:51 /90Days | $49.31 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:26 /31Days | $49.31 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:26 /31Days | $49.31 |
Browse Plan Formulary |
Blue Medicare Advantage Plus (HMO)
|
$17.00 |
$0 |
Few Generics |
1 |
Preferred Generic |
$3.00 | $9.00 | Q:23 /30Days | $49.30 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$19.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $49.51 |
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)
|
$23.70 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | Q:17 /30Days | $50.69 |
Browse Plan Formulary |
Advantage by Bridgeway Health Solutions (HMO SNP)
|
$27.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:36 /30Days | $50.33 |
Browse Plan Formulary |
Health Choice Generations (HMO SNP)
|
$27.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:17 /30Days | $47.69 |
Browse Plan Formulary |
Health Net Amber (HMO SNP)
|
$27.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$41.00 | $113.00 | None | $49.06 |
Browse Plan Formulary |
Maricopa Care Advantage (HMO SNP)
|
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:17 /25Days | $50.36 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
|
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:17 /30Days | $49.19 |
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)
|
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:17 /30Days | $49.19 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
|
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:17 /30Days | $49.19 |
Browse Plan Formulary |
Phoenix Advantage Plus (HMO SNP)
|
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:51 /90Days | $49.32 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$27.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $49.49 |
Browse Plan Formulary |
HumanaChoice R5826-014 P (Regional PPO)
|
$32.30 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:36 /30Days | $48.80 |
Browse Plan Formulary |
Phoenix Advantage Select (HMO)
|
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:51 /90Days | $49.31 |
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)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $49.06 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $49.10 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $48.99 |
Browse Plan Formulary |
Blue Medicare Advantage Premier (HMO)
|
$55.00 |
$0 |
Few Generics |
1 |
Preferred Generic |
$2.00 | $6.00 | Q:23 /30Days | $49.30 |
Browse Plan Formulary |
Humana Gold Plus H2649-030 (HMO-POS)
|
$79.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:36 /30Days | $48.81 |
Browse Plan Formulary |
HumanaChoice H0317-001 (PPO)
|
$122.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:36 /30Days | $48.81 |
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)
|
$180.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:36 /30Days | $48.80 |
Browse Plan Formulary |