LEVOCARNITINE TABLET 330MG 90 BLPK (90 BLPK) (NDC: 64980013009)
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 SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$45.00 | $125.00 | P | $89.14 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$45.00 | $125.00 | P | $89.14 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
Few Generics |
2 |
Preferred Brand |
25% | 25% | P | $118.60 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$14.00 | $28.00 | P | $126.28 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $115.67 |
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 |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $115.67 |
Browse Plan Formulary |
Brand New Day Dementia with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P | $110.56 |
Browse Plan Formulary |
Brand New Day Diabetes with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P | $110.56 |
Browse Plan Formulary |
Brand New Day Enhanced Drug Savings for So Cal (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P | $110.67 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $110.12 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$310* |
Many Generics |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $110.12 |
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 ESRD (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $110.12 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $110.12 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $110.12 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $110.12 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $110.12 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $109.75 |
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 |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $109.75 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P | $110.48 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$4.00 | $8.00 | P | $90.06 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $107.95 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $108.22 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$4.00 | $8.00 | None | $108.22 |
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 Healthy Heart (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$4.00 | $8.00 | None | $107.95 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $107.99 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$4.00 | $8.00 | None | $107.95 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$4.00 | $8.00 | None | $108.22 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | P | $114.83 |
Browse Plan Formulary |
Humana Gold Plus H0108-011 (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | P | $107.39 |
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 |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 |
Some Generics |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $109.75 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P | $122.85 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
25% | n/a | P | $109.03 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | P | $114.83 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P | $114.22 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P | $114.65 |
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 |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$4.00 |
$0 |
to be determined |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P | $124.31 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$14.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P | $124.31 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$16.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P | $90.08 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$21.60 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Generic |
$0.00 | $0.00 | P | $117.71 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$24.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | P | $114.22 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$24.40 |
$310 |
Call plan for details |
2 |
Non-Preferred Generic |
25% | 17% | P | $109.03 |
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 |
SCAN Plus (HMO)
|
$28.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $114.07 |
Browse Plan Formulary |
Brand New Day Dementia with Extra Care (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $110.56 |
Browse Plan Formulary |
Brand New Day Diabetes with Extra Care (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $110.56 |
Browse Plan Formulary |
Brand New Day Dual Coverage (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | P | $110.56 |
Browse Plan Formulary |
Brand New Day Extra Care (HMO)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $110.52 |
Browse Plan Formulary |
Brand New Day for Mental Illness (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $110.52 |
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 |
Central Health Medi-Medi Plan (HMO SNP)
|
$28.10 |
$310* |
Many Generics |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $109.75 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$28.10 |
$310* |
Many Generics |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $109.75 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $107.99 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $108.02 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | P | $109.21 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | P | $114.22 |
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 |
VillageHealth (HMO SNP)
|
$28.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $114.83 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$8.00 | $24.00 | None | $109.75 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$80.00 |
$149 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | P | $126.13 |
Browse Plan Formulary |