HYDROMORPHONE HCL 8MG TABLET (100 CT) (100 BOT) (NDC: 00406324901)
2015 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 |
$205* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $16.00 | Q:330 /30Days | $41.87 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
50% | 50% | Q:240 /30Days | $183.71 |
Browse Plan Formulary |
Blue Medicare Advantage Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
$9.00 | $27.00 | None | $105.86 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:180 /30Days | $100.74 |
Browse Plan Formulary |
CareMore Diabetes (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:180 /30Days | $100.74 |
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 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:180 /30Days | $100.74 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.50 | $26.25 | Q:180 /30Days | $100.74 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:180 /30Days | $100.74 |
Browse Plan Formulary |
Cigna-HealthSpring Achieve Plus (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:240 /30Days | $55.78 |
Browse Plan Formulary |
Cigna-HealthSpring Preferred (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:240 /30Days | $55.78 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$34.00 | $92.00 | Q:7 /1Days | $74.08 |
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 |
$34.00 | $92.00 | Q:7 /1Days | $74.08 |
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 | Q:7 /1Days | $73.82 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:240 /30Days | $69.59 |
Browse Plan Formulary |
Humana Gold Plus H2649-032 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:240 /30Days | $69.59 |
Browse Plan Formulary |
Phoenix Advantage (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:270 /30Days | $129.71 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $93.21 |
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 Medicare Advantage Plus (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
$9.00 | $27.00 | None | $105.86 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$29.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:330 /30Days | $42.27 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$30.20 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:330 /30Days | $41.85 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete ONE (HMO SNP)
|
$31.30 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:330 /30Days | $42.18 |
Browse Plan Formulary |
Bridgeway Health Solutions Advantage (HMO SNP)
|
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $168.63 |
Browse Plan Formulary |
Care1st+ (HMO SNP)
|
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
25% | n/a | Q:120 /30Days | $169.05 |
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 Amber (HMO SNP)
|
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$20.00 | $57.00 | Q:7 /1Days | $73.82 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
|
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $150.91 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
|
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $150.91 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
|
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $150.91 |
Browse Plan Formulary |
Mercy Maricopa Advantage (HMO SNP)
|
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $150.91 |
Browse Plan Formulary |
Health Choice Generations (HMO SNP)
|
$32.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $100.88 |
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 |
Maricopa Care Advantage (HMO SNP)
|
$32.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:240 /30Days | $165.52 |
Browse Plan Formulary |
Phoenix Advantage Plus (HMO SNP)
|
$32.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $129.71 |
Browse Plan Formulary |
Phoenix Advantage Select (HMO)
|
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:270 /30Days | $129.71 |
Browse Plan Formulary |
HumanaChoice R5826-014 (Regional PPO)
|
$41.00 |
$190 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:240 /30Days | $69.59 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:7 /1Days | $74.08 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:7 /1Days | $74.08 |
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 |
Cigna-HealthSpring Preferred Plus (HMO)
|
$50.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | Q:240 /30Days | $55.78 |
Browse Plan Formulary |
Blue Medicare Advantage Premier (HMO)
|
$62.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None | $105.86 |
Browse Plan Formulary |
Humana Gold Plus H2649-030 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:240 /30Days | $69.59 |
Browse Plan Formulary |
HumanaChoice H6609-133 (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:240 /30Days | $69.59 |
Browse Plan Formulary |
Humana Gold Choice H8145-103 (PFFS)
|
$178.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:240 /30Days | $69.59 |
Browse Plan Formulary |