ARISTADA ER 662 MG/2.4 ML SYRN (2.4 ML ) (NDC: 65757040203)
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 Mosaic (HMO)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | 27% | None | $1,688.71 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$330 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,688.71 |
Browse Plan Formulary |
Advantage Health NYC - SNP (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,729.85 |
Browse Plan Formulary |
Advantage Silver - NY City (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,729.85 |
Browse Plan Formulary |
Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $1,789.09 |
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 |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$160 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $1,713.97 |
Browse Plan Formulary |
AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | S | $1,650.68 |
Browse Plan Formulary |
AgeWell New York LiveWell (HMO)
|
$0.00 |
$275 |
to be determined |
5 |
Specialty Tier |
25% | 25% | S | $1,650.68 |
Browse Plan Formulary |
AlphaCare Renew (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,663.11 |
Browse Plan Formulary |
AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand Drugs |
0% | 0% | None | $1,663.11 |
Browse Plan Formulary |
Amida Care True Life Plus (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Preferred Brand |
$33.00 | $99.00 | None | $1,699.70 |
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 |
CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,693.66 |
Browse Plan Formulary |
Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | Q:2 /28Days | $1,694.41 |
Browse Plan Formulary |
Centers Plan for Medicare Advantage Care (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Specialty Tier |
33% | 33% | Q:2 /28Days | $1,694.41 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P Q:2 /30Days | $1,700.13 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P Q:2 /30Days | $1,700.13 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
5 |
Specialty Tier |
27% | n/a | P Q:2 /30Days | $1,700.13 |
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 |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,807.34 |
Browse Plan Formulary |
GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $1,699.57 |
Browse Plan Formulary |
Humana Gold Plus H3533-005 (HMO)
|
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,675.33 |
Browse Plan Formulary |
ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | Q:2 /28Days | $1,692.04 |
Browse Plan Formulary |
Liberty Health Advantage Preferred Choice (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,709.74 |
Browse Plan Formulary |
PHP Care Complete FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | n/a | P Q:2 /28Days | $1,643.19 |
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 |
SWH Whole Health FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | None | $1,700.32 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
|
$0.00 |
$290 |
to be determined |
5 |
Specialty Tier |
26% | 26% | None | $1,688.71 |
Browse Plan Formulary |
VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | Q:2 /28Days | $1,695.21 |
Browse Plan Formulary |
VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | Q:2 /28Days | $1,713.85 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
|
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | Q:2 /28Days | $1,713.85 |
Browse Plan Formulary |
Access Medicare Gold (HMO)
|
$10.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | Q:2 /28Days | $1,692.27 |
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 H3533-021 (HMO)
|
$24.10 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,675.33 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$29.00 |
$230 |
to be determined |
5 |
Specialty Tier |
27% | 27% | None | $1,688.71 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
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 SNP-DE H3533-004 (HMO SNP)
|
$32.50 |
$165 |
to be determined |
5 |
Specialty Tier |
29% | n/a | Q:2 /28Days | $1,675.33 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$35.90 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | None | $1,688.71 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
|
$39.00 |
$150 |
to be determined |
5 |
Specialty Tier |
29% | 29% | None | $1,688.71 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$39.30 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,688.71 |
Browse Plan Formulary |
Access Medicare Pearl (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | Q:2 /28Days | $1,692.27 |
Browse Plan Formulary |
Access Medicare Pearl Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | Q:2 /28Days | $1,692.27 |
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 |
Access Medicare Platinum (HMO)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:2 /28Days | $1,692.27 |
Browse Plan Formulary |
Access Medicare Platinum Advantage (HMO)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:2 /28Days | $1,692.27 |
Browse Plan Formulary |
Advantage Value One NY - Dual (HMO SNP)
|
$39.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,729.85 |
Browse Plan Formulary |
AgeWell New York BeWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | S | $1,650.68 |
Browse Plan Formulary |
AgeWell New York CareWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | S | $1,650.68 |
Browse Plan Formulary |
AgeWell New York FeelWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | S | $1,650.68 |
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 |
AlphaCare Resilience (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,663.11 |
Browse Plan Formulary |
AlphaCare Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | None | $1,663.11 |
Browse Plan Formulary |
Amida Care Live Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
3 |
Preferred Brand |
25% | 25% | None | $1,699.70 |
Browse Plan Formulary |
Amida Care True Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $1,699.70 |
Browse Plan Formulary |
CenterLight Healthcare Direct Complete Plan (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Brand |
25% | 25% | P | $1,693.66 |
Browse Plan Formulary |
Centers Plan for Dual Coverage Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Tier 4 |
15% | 15% | Q:2 /28Days | $1,696.22 |
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 |
Centers Plan for Nursing Home Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:2 /28Days | $1,696.22 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (PPO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | P Q:2 /30Days | $1,700.13 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,807.34 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,807.34 |
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 |
Fidelis Medicaid Advantage Plus (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,807.34 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$39.70 |
$250 |
to be determined |
5 |
Specialty Tier |
27% | n/a | Q:2 /28Days | $1,807.34 |
Browse Plan Formulary |
GuildNet Gold (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
Liberty Health Advantage Dual Power (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | Q:2 /28Days | $1,703.22 |
Browse Plan Formulary |
Senior Whole Health of New York NHC (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,699.47 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:2 /28Days | $1,713.85 |
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 |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | Q:2 /28Days | $1,713.85 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | Q:2 /28Days | $1,713.85 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$69.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,688.71 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
|
$69.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $1,688.71 |
Browse Plan Formulary |
Advantage Platinum Plus NY (HMO)
|
$85.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,729.85 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$96.00 |
$150 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $1,713.97 |
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 |
VNSNY CHOICE Medicare Ultra (HMO-POS)
|
$96.40 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | Q:2 /28Days | $1,713.85 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$115.80 |
$360 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | Q:2 /28Days | $1,713.85 |
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 Connect Plus (PPO)
|
$188.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $1,713.97 |
Browse Plan Formulary |
EmblemHealth Advantage (PPO)
|
$223.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,699.57 |
Browse Plan Formulary |