Sirolimus 0.5 MG Tablet [Rapamune] (NDC: 68382052001)
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 |
Commonwealth Care Alliance (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic Drugs |
0% | 0% | P | $207.34 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
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 |
Fallon Senior Plan Super Saver Rx (HMO)
|
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$12.00 | $24.00 | P | $191.36 |
Browse Plan Formulary |
Tufts Health Unify (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic Drugs |
0% | 0% | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
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 |
HNE Medicare Value (HMO)
|
$20.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$10.00 | $20.00 | P | $196.22 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$26.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$26.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$26.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$26.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$27.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $16.00 | P | $191.36 |
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 |
Senior Care Options Program (HMO SNP)
|
$29.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P | $207.34 |
Browse Plan Formulary |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$29.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P | $195.75 |
Browse Plan Formulary |
NaviCare (HMO SNP)
|
$29.70 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | P | $220.66 |
Browse Plan Formulary |
AARP MedicareComplete Choice (Regional PPO)
|
$29.90 |
$255 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $184.52 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$46.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$46.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
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 |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$46.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$49.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$8.00 | $16.00 | P | $191.36 |
Browse Plan Formulary |
HNE Medicare Basic (HMO)
|
$75.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic |
$10.00 | $20.00 | P | $196.22 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$76.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$76.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$76.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $21.00 | P | $195.75 |
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 |
Fallon Senior Plan Plus Enhanced Rx (HMO-POS)
|
$106.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$5.00 | $15.00 | P | $223.82 |
Browse Plan Formulary |
HNE Medicare Plus (HMO)
|
$106.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic |
$10.00 | $20.00 | P | $196.22 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$110.20 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$5.00 | $12.00 | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$110.20 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$5.00 | $12.00 | P | $195.75 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$110.20 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Non-Preferred Generic |
$5.00 | $12.00 | P | $195.75 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
|
$153.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$6.00 | $12.00 | P | $191.36 |
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 |
HNE Medicare Premium (HMO)
|
$156.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic |
$10.00 | $20.00 | P | $196.22 |
Browse Plan Formulary |
Medicare HMO Blue PlusRx (HMO)
|
$193.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$6.00 | $12.00 | P | $191.36 |
Browse Plan Formulary |
HNE Medicare Freedom (HMO-POS)
|
$210.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
$10.00 | $20.00 | P | $196.22 |
Browse Plan Formulary |