OLANZAPINE 7.5 MG TABLET [Zyprexa] (NDC: 00093576956)
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 |
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 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
50% | 50% | Q:30 /30Days | $19.67 |
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Anthem Dual Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Dual Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$31.00 | $93.00 | Q:80 /30Days | $143.60 |
Browse Plan Formulary |
Anthem Senior Advantage Basic (HMO)
![Email Prescription and/or Health Benefit details for Anthem Senior Advantage Basic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$153 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$37.00 | $111.00 | Q:80 /30Days | $143.88 |
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CareSource MyCare Ohio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for CareSource MyCare Ohio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic Drugs |
0% | 0% | Q:30 /30Days | $7.78 |
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Gateway Health Medicare Assured Select (HMO)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:30 /30Days | $12.14 |
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 |
HealthSpan Medicare Standard (HMO)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Standard (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 |
$14.00 | $28.00 | None | $12.07 |
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Humana Gold Plus H8953-006 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8953-006 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$320* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $7.49 |
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PrimeTime Health Plan Aultimate (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Aultimate (HMO-POS)](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 |
$15.00 | $45.00 | None | $37.54 |
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SecureCare - Option IV (HMO)
![Email Prescription and/or Health Benefit details for SecureCare - Option IV (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 |
$20.00 | $40.00 | Q:81 /30Days | $98.39 |
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SummaCare Medicare Topaz (HMO)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Topaz (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100* |
to be determined |
2* |
Tier 2 |
$15.00 | $37.50 | Q:30 /30Days | $57.06 |
Browse Plan Formulary |
UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic Drugs |
0% | 0% | Q:30 /30Days | $7.54 |
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 |
HealthSpan Medicare Core 2 (HMO)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Core 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$2.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $10.84 |
Browse Plan Formulary |
HealthSpan Medicare Plus IV (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus IV (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$30.00 | $60.00 | None | $12.69 |
Browse Plan Formulary |
Buckeye Health Plan Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Buckeye Health Plan Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $13.04 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Diamond (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:30 /30Days | $12.14 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Ruby (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:30 /30Days | $12.14 |
Browse Plan Formulary |
SecureCare SNP (HMO SNP)
![Email Prescription and/or Health Benefit details for SecureCare SNP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:81 /30Days | $98.39 |
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 |
PrimeTime Health Plan Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $24.00 | None | $37.54 |
Browse Plan Formulary |
SummaCare Medicare Ruby (HMO)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Ruby (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | Q:30 /30Days | $57.12 |
Browse Plan Formulary |
HumanaChoice R5826-007 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-007 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $7.49 |
Browse Plan Formulary |
HealthSpan Medicare Plus III (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus III (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$20.00 | $40.00 | None | $12.69 |
Browse Plan Formulary |
Gateway Health Medicare Assured Gold (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Gold (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | Q:30 /30Days | $12.14 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
![Email Prescription and/or Health Benefit details for Blue Medicare Access Value (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.80 |
$115 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:80 /30Days | $141.13 |
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 |
HealthSpan Medicare Plus II (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus II (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.10 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$14.00 | $28.00 | None | $12.69 |
Browse Plan Formulary |
HealthSpan Medicare Enhanced (HMO)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Enhanced (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$14.00 | $28.00 | None | $12.07 |
Browse Plan Formulary |
HealthSpan Medicare Plus I - B only (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus I - B only (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$14.00 | $28.00 | None | $12.69 |
Browse Plan Formulary |
Gateway Health Medicare Assured Choice (HMO)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$20.00 | $40.00 | Q:30 /30Days | $12.14 |
Browse Plan Formulary |
Anthem Senior Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem Senior Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$64.00 |
$123 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:80 /30Days | $151.28 |
Browse Plan Formulary |
SecureCare - Option II (HMO)
![Email Prescription and/or Health Benefit details for SecureCare - Option II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$66.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | Q:81 /30Days | $98.39 |
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 |
PrimeTime Health Plan Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $24.00 | None | $37.54 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$71.00 |
$165 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:80 /30Days | $137.31 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$71.00 |
$165 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:80 /30Days | $151.56 |
Browse Plan Formulary |
HumanaChoice H6609-082 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H6609-082 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$320* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $7.49 |
Browse Plan Formulary |
Gateway Health Medicare Assured Platinum (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Platinum (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | Q:30 /30Days | $12.14 |
Browse Plan Formulary |
SummaCare Medicare Sapphire (HMO-POS)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Sapphire (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $37.50 | Q:30 /30Days | $57.12 |
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 |
Gateway Health Medicare Assured Prime (HMO)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$82.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$20.00 | $40.00 | Q:30 /30Days | $12.14 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$100.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
50% | 50% | Q:30 /30Days | $19.90 |
Browse Plan Formulary |
Aetna Medicare Select Plus Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plus Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$139.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
50% | 50% | Q:30 /30Days | $19.61 |
Browse Plan Formulary |
HealthSpan Medicare Plus I (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus I (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
$14.00 | $28.00 | None | $12.69 |
Browse Plan Formulary |
SummaCare Medicare Emerald (HMO-POS)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Emerald (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$182.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | Q:30 /30Days | $57.81 |
Browse Plan Formulary |