ANADROL-50 TABLET (100 EA ) (NDC: 68220005510)
2016 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 SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,217.70 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,217.70 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,217.70 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,217.70 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,240.96 |
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 |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,240.96 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$88.00 | $176.00 | None | $1,182.04 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$88.00 | $176.00 | None | $1,182.04 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$65.00 | $130.00 | None | $1,182.04 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,223.45 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,223.45 |
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 |
Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,223.45 |
Browse Plan Formulary |
Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,223.45 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,217.69 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $1,245.08 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $1,245.08 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,322.81 |
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 Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,240.71 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,322.81 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,240.71 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,240.71 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,240.71 |
Browse Plan Formulary |
Heart & Diabetes (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,243.09 |
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 |
Heart & Diabetes (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,243.09 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,171.49 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,171.49 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $237.50 | None | $1,260.34 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | None | $1,244.17 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | None | $1,244.17 |
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 |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $1,244.17 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $1,244.17 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $1,221.56 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $1,221.56 |
Browse Plan Formulary |
My Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,243.09 |
Browse Plan Formulary |
My Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,243.09 |
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 |
Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,243.09 |
Browse Plan Formulary |
Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,243.09 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,203.20 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,203.20 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,208.14 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,208.14 |
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 |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,203.20 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P | $1,203.20 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,322.81 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,240.71 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,322.81 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,240.71 |
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 |
Humana Gold Plus H5619-037 (HMO)
|
$23.40 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | None | $1,171.49 |
Browse Plan Formulary |
Humana Gold Plus H5619-037 (HMO)
|
$23.40 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | None | $1,171.49 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$25.20 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None | $1,244.17 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$25.20 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None | $1,244.17 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$27.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,233.86 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$27.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,233.86 |
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 |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$27.40 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,217.70 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$27.40 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,217.70 |
Browse Plan Formulary |
CalPlus Plan (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,243.09 |
Browse Plan Formulary |
CalPlus Plan (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,243.09 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $1,223.45 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $1,223.45 |
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 |
Coordinated Choice Plan (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $1,223.45 |
Browse Plan Formulary |
Coordinated Choice Plan (HMO)
|
$31.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | P | $1,223.45 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$31.00 |
$270 |
to be determined |
5 |
Specialty Tier |
27% | 27% | None | $1,245.19 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$31.00 |
$270 |
to be determined |
5 |
Specialty Tier |
27% | 27% | None | $1,245.19 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,309.64 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,244.58 |
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 Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,309.64 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,244.58 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,309.64 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,245.19 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,309.64 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,245.19 |
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 Seniority Plus Sapphire Premier (HMO)
|
$31.00 |
$310 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,244.58 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$31.00 |
$310 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,244.58 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $1,208.14 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $1,208.14 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $1,208.14 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | P | $1,208.14 |
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 |
SCAN Plus (HMO)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,207.34 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,207.34 |
Browse Plan Formulary |
VillageHealth (HMO-POS SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,203.20 |
Browse Plan Formulary |
VillageHealth (HMO-POS SNP)
|
$31.10 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,203.20 |
Browse Plan Formulary |
Humana Gold Plus H5619-022 (HMO)
|
$39.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,171.49 |
Browse Plan Formulary |
Humana Gold Plus H5619-022 (HMO)
|
$39.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,171.49 |
Browse Plan Formulary |