EXFORGE 5MG-320MG TABLET (30 BOT) (NDC: 00078049015)
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 Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $198.54 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Few Generics |
2 |
Preferred Brand |
$45.00 | $90.00 | Q:1 /1Days | $198.98 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $197.38 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$5.00 | $15.00 | Q:30 /30Days | $201.35 |
Browse Plan Formulary |
AvMed Medicare Choice Elect (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:30 /30Days | $201.35 |
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 |
BlueMedicare HMO LifeTime (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$25.00 | $75.00 | Q:30 /30Days | $198.07 |
Browse Plan Formulary |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$25.00 | $75.00 | Q:30 /30Days | $198.07 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$30 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days | $197.97 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $195.90 |
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 |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $197.91 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-188 (HMO SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:30 /30Days | $195.90 |
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 R5826-074 (Regional PPO)
|
$0.00 |
$150* |
Few Generics, Few Brands |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.71 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Brand |
$0.00 | n/a | Q:30 /30Days | $197.13 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$5.00 | n/a | None | $198.55 |
Browse Plan Formulary |
Preferred Choice Dade (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$0.00 | $0.00 | None | $198.55 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
|
$0.00 |
$0 |
Many Generics, Some Brands |
2 |
Preferred Brand |
$0.00 | $0.00 | None | $198.55 |
Browse Plan Formulary |
Preferred Medical Plan Choice (HMO)
|
$0.00 |
$0 |
Many Generics, Many Brands |
3 |
Preferred Brand |
$0.00 | $0.00 | S | $200.20 |
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 |
Preferred Medical Plan Value (HMO)
|
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$25.00 | $75.00 | S | $200.20 |
Browse Plan Formulary |
Preferred Special Care Miami-Dade (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$0.00 | $0.00 | None | $198.55 |
Browse Plan Formulary |
Simply Clear (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
25% | n/a | None | $194.65 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$55.00 | n/a | None | $194.66 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
4 |
Non-Preferred Brand |
$15.00 | n/a | None | $194.66 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$10.00 | n/a | None | $194.66 |
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 |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$30.00 | n/a | None | $194.66 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$0.00 | n/a | Q:30 /30Days | $197.91 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$0.00 | n/a | Q:30 /30Days | $197.91 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-187 (HMO SNP)
|
$7.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
WellCare Select (HMO SNP)
|
$11.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$88.00 | $176.00 | None | $202.05 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$11.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.90 |
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-DE H1036-163 (HMO SNP)
|
$12.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$84.00 | $168.00 | None | $202.06 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$13.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$17.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$88.00 | $176.00 | None | $202.06 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$19.90 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $198.55 |
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 |
Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)
|
$20.60 |
$0 |
Many Generics |
2 |
Preferred Brand |
25% | n/a | None | $198.55 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$21.20 |
$0 |
Many Generics |
2 |
Preferred Brand |
$0.00 | $0.00 | None | $198.55 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$21.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $198.54 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$22.00 |
$310 |
Many Generics, Few Brands |
2 |
Preferred Brand |
$0.00 | $0.00 | Q:30 /30Days | $197.38 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $197.38 |
Browse Plan Formulary |
MediMax (HMO)
|
$22.10 |
$310 |
Call plan for details |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $197.88 |
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 |
Simply Care (HMO SNP)
|
$22.10 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$25.00 | n/a | None | $194.66 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$22.10 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$25.00 | n/a | None | $194.66 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$22.10 |
$310 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | n/a | None | $194.66 |
Browse Plan Formulary |
Touch Institutional Special Needs Plan (HMO SNP)
|
$22.10 |
$310 |
Some Generics |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $197.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$35.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $90.00 | Q:1 /1Days | $198.98 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$36.60 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$40.00 | $110.00 | Q:30 /30Days | $195.71 |
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 H5415-056 (PPO)
|
$45.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.85 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$103.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $195.73 |
Browse Plan Formulary |