PROPRANOLOL HCL TABLET USP 40MG (1000 CT) (1000 BOTPL) (NDC: 50111046903)
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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
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 |
Meridian Prime (HMO)
|
$0.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $30.51 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $44.29 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $43.77 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $44.23 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $44.29 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $43.84 |
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 |
Medicare Plus Blue PPO Essential (PPO)
|
$15.50 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$15.50 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$15.50 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$15.50 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$15.50 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$28.20 |
$320 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $33.59 |
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 |
Molina Medicare Options Plus (HMO SNP)
|
$28.60 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Generic |
$0.00 | $0.00 | None | $40.07 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO SNP)
|
$30.40 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $41.85 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
|
$31.40 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $30.51 |
Browse Plan Formulary |
Fidelis Secure Freedom (HMO SNP)
|
$31.50 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $8.00 | None | $41.85 |
Browse Plan Formulary |
McLaren Advantage Sapphire (HMO)
|
$36.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$5.00 | n/a | None | $33.17 |
Browse Plan Formulary |
McLaren Advantage Sapphire (HMO)
|
$36.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$5.00 | n/a | None | $33.63 |
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 |
BCN Advantage HMO ConnectedCare (HMO)
|
$41.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $12.50 | None | $29.15 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$55.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$6.00 | $15.00 | None | $40.67 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$58.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $12.50 | None | $43.84 |
Browse Plan Formulary |
McLaren Advantage Diamond (HMO)
|
$72.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$5.00 | n/a | None | $33.17 |
Browse Plan Formulary |
McLaren Advantage Diamond (HMO)
|
$72.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$5.00 | n/a | None | $33.63 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$75.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$75.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$75.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$75.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$75.00 |
$320 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $29.15 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $43.77 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $44.23 |
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 |
PriorityMedicare Merit (PPO)
|
$95.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $44.29 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $43.84 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $44.29 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$103.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$103.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$103.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$103.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$103.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$106.00 |
$100* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | $5.00 | None | $40.67 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$126.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $5.00 | None | $40.67 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$146.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $43.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$157.00 |
$95* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$157.00 |
$95* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$157.00 |
$95* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$157.00 |
$95* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$157.00 |
$95* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$178.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $43.84 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$178.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $44.29 |
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 |
PriorityMedicare Select (PPO)
|
$178.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $43.77 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$178.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $44.23 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$178.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $10.00 | None | $44.29 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$192.00 |
$50* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$4.00 | $10.00 | None | $40.67 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$210.00 |
$150* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$4.00 | $10.00 | None | $40.67 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$232.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$232.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$232.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$232.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$232.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$3.00 | $7.50 | None | $29.15 |
Browse Plan Formulary |