HYDROMORPHONE HYDROCHLORIDE 2MG TABLETS (100 BOTPL ) (NDC: 00527135301)
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)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$205* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $16.00 | Q:240 /30Days | $12.93 |
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Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
50% | 50% | Q:480 /30Days | $32.87 |
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Blue Medicare Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for Blue Medicare Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
$9.00 | $27.00 | None | $23.18 |
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CareMore Breathe (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Breathe (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:360 /30Days | $25.74 |
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CareMore Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:360 /30Days | $25.74 |
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)
![Email Prescription and/or Health Benefit details for CareMore Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:360 /30Days | $25.74 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for CareMore StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.50 | $26.25 | Q:360 /30Days | $25.74 |
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CareMore Value Plus (HMO)
![Email Prescription and/or Health Benefit details for CareMore Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$7.50 | $18.75 | Q:360 /30Days | $25.74 |
Browse Plan Formulary |
Cigna-HealthSpring Achieve Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Cigna-HealthSpring Achieve Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:240 /30Days | $9.99 |
Browse Plan Formulary |
Cigna-HealthSpring Preferred (HMO)
![Email Prescription and/or Health Benefit details for Cigna-HealthSpring Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:240 /30Days | $9.99 |
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Health Net Jade (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$34.00 | $92.00 | Q:29 /1Days | $22.28 |
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)
![Email Prescription and/or Health Benefit details for Health Net Jade Cardiovascular (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$34.00 | $92.00 | Q:29 /1Days | $22.28 |
Browse Plan Formulary |
Health Net Ruby Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$44.00 | $122.00 | Q:29 /1Days | $22.03 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:360 /30Days | $13.19 |
Browse Plan Formulary |
Humana Gold Plus H2649-032 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H2649-032 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:360 /30Days | $13.19 |
Browse Plan Formulary |
Phoenix Advantage (HMO)
![Email Prescription and/or Health Benefit details for Phoenix Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:270 /30Days | $14.75 |
Browse Plan Formulary |
SCAN Classic (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $19.69 |
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)
![Email Prescription and/or Health Benefit details for Blue Medicare Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
$9.00 | $27.00 | None | $23.18 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:240 /30Days | $12.97 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.20 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:240 /30Days | $12.91 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete ONE (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete ONE (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.30 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:240 /30Days | $12.96 |
Browse Plan Formulary |
Bridgeway Health Solutions Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Bridgeway Health Solutions Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $28.15 |
Browse Plan Formulary |
Care1st+ (HMO SNP)
![Email Prescription and/or Health Benefit details for Care1st+ (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
25% | n/a | Q:120 /30Days | $30.80 |
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)
![Email Prescription and/or Health Benefit details for Health Net Amber (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$20.00 | $57.00 | Q:29 /1Days | $22.03 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Mercy Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $23.31 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Mercy Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $23.31 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Mercy Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $23.31 |
Browse Plan Formulary |
Mercy Maricopa Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Mercy Maricopa Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $23.31 |
Browse Plan Formulary |
Health Choice Generations (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Choice Generations (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $21.74 |
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 |
Maricopa Care Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Maricopa Care Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:180 /30Days | $30.29 |
Browse Plan Formulary |
Phoenix Advantage Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Phoenix Advantage Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:270 /30Days | $14.75 |
Browse Plan Formulary |
Phoenix Advantage Select (HMO)
![Email Prescription and/or Health Benefit details for Phoenix Advantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:270 /30Days | $14.75 |
Browse Plan Formulary |
HumanaChoice R5826-014 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-014 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$190 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:360 /30Days | $13.19 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:29 /1Days | $22.28 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Ruby 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:29 /1Days | $22.28 |
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)
![Email Prescription and/or Health Benefit details for Cigna-HealthSpring Preferred Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | Q:240 /30Days | $9.99 |
Browse Plan Formulary |
Blue Medicare Advantage Premier (HMO)
![Email Prescription and/or Health Benefit details for Blue Medicare Advantage Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$62.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None | $23.18 |
Browse Plan Formulary |
Humana Gold Plus H2649-030 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H2649-030 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:360 /30Days | $13.19 |
Browse Plan Formulary |
HumanaChoice H6609-133 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H6609-133 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:360 /30Days | $13.19 |
Browse Plan Formulary |
Humana Gold Choice H8145-103 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-103 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$178.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:360 /30Days | $13.19 |
Browse Plan Formulary |