ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER (30 VIAL) (NDC: 00487990401)
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 |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$18.00 | $36.00 | P | $180.78 |
Browse Plan Formulary |
Humana Gold Plus H3533-006 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$18.00 | $0.00 | P | $140.69 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | P | $153.43 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $187.82 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P | $202.67 |
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 |
Humana Gold Plus HMO-SNP-DE H3533-008 (HMO SNP)
|
$13.80 |
$110* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$13.00 | $0.00 | P | $140.69 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$2.00 | $4.00 | P | $202.49 |
Browse Plan Formulary |
BasiCare with Part D (PPO)
|
$27.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $205.09 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$31.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | P | $187.82 |
Browse Plan Formulary |
CDPHP Value Rx (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$9.00 | $18.00 | Q:300 /30Days | $178.82 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$32.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$2.00 | $4.00 | P | $211.58 |
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 |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$35.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $146.54 |
Browse Plan Formulary |
Today''s Options Advantage Plus 850B (PPO)
|
$36.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $12.00 | P | $187.82 |
Browse Plan Formulary |
Today''s Options Premier Plus 850B (PFFS)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $12.00 | P | $187.82 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO SNP)
|
$37.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | P | $180.78 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
|
$37.20 |
$310 |
Some Generics |
2 |
Non-Preferred Generic |
$23.00 | $46.00 | P | $180.78 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO SNP)
|
$37.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$29.00 | $58.00 | P | $180.78 |
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 |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$37.20 |
$240* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$15.00 | $30.00 | P | $180.78 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
|
$37.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $187.82 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$37.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | P | $187.82 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$37.20 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | P | $187.82 |
Browse Plan Formulary |
BlueShield Senior Blue 650 Part D (HMO-POS)
|
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $7.50 | P | $144.30 |
Browse Plan Formulary |
Fidelis Long Term Care Advantage (HMO SNP)
|
$44.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P | $180.78 |
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 |
HumanaChoice H5970-008 (PPO)
|
$48.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$15.00 | $0.00 | P | $140.69 |
Browse Plan Formulary |
Empire MediBlue Freedom I (PPO)
|
$50.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$11.00 | $22.00 | P Q:360 /30Days | $200.50 |
Browse Plan Formulary |
GoldValue with Part D (HMO-POS)
|
$59.50 |
$0 |
Few Generics |
1 |
Preferred Generic |
$10.00 | $20.00 | P | $204.01 |
Browse Plan Formulary |
GoldAnywhere with Part D - Option 2 (PPO)
|
$64.00 |
$0 |
Few Generics |
1 |
Preferred Generic |
$10.00 | $20.00 | P | $205.09 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | P Q:360 /30Days | $204.10 |
Browse Plan Formulary |
Empire MediBlue Freedom II (PPO)
|
$72.00 |
$90* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $16.00 | P Q:360 /30Days | $204.10 |
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 |
CDPHP Choice Rx (HMO)
|
$81.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:300 /30Days | $178.82 |
Browse Plan Formulary |
Today''s Options Advantage Plus 350A (PPO)
|
$90.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$7.00 | $7.00 | P | $187.82 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$92.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$7.00 | $7.00 | P | $187.82 |
Browse Plan Formulary |
BlueShield Senior Blue HMO 652 PartD (HMO)
|
$99.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $7.50 | P | $144.30 |
Browse Plan Formulary |
Preferred Gold with Part D (HMO-POS)
|
$117.00 |
$0 |
Few Generics |
1 |
Preferred Generic |
$10.00 | $20.00 | P | $204.01 |
Browse Plan Formulary |
CDPHP Core Rx (PPO)
|
$126.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:300 /30Days | $178.82 |
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 |
HumanaChoice H5970-010 (PPO)
|
$133.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$15.00 | $0.00 | P | $140.69 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 750 (PPO)
|
$144.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $12.50 | P | $144.30 |
Browse Plan Formulary |
CDPHP Classic Rx (PPO)
|
$182.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | Q:300 /30Days | $178.82 |
Browse Plan Formulary |
GoldAnywhere with Part D - Option 1 (PPO)
|
$238.00 |
$0 |
Few Generics |
1 |
Preferred Generic |
$8.00 | $16.00 | P | $205.09 |
Browse Plan Formulary |
CDPHP Prime Rx (PPO)
|
$256.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:300 /30Days | $178.82 |
Browse Plan Formulary |