Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir] (NDC: 68180028607)
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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,459.28 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
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 |
Harbor Medicare (HMO)
|
$0.00 |
$240 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $1,374.04 |
Browse Plan Formulary |
HealthPlus MedicarePlus Option 0 (HMO)
|
$0.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | 25% | None | $1,306.15 |
Browse Plan Formulary |
Meridian Prime (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | None | $871.25 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,286.13 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,441.51 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,332.34 |
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 |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,274.20 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,438.36 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,438.36 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,286.13 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,441.51 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,274.20 |
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 Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,332.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,459.28 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
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 |
McLaren Advantage Sapphire (HMO)
|
$29.00 |
$150 |
to be determined |
4 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $1,323.75 |
Browse Plan Formulary |
McLaren Advantage Sapphire (HMO)
|
$29.00 |
$150 |
to be determined |
4 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $1,353.29 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS SNP)
|
$29.10 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | Q:90 /30Days | $1,230.52 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$33.00 |
$360 |
to be determined |
5 |
Specialty Tier |
25% | n/a | None | $1,304.87 |
Browse Plan Formulary |
HAP Midwest Health Plan (HMO SNP)
|
$33.50 |
$360 |
to be determined |
1 |
Generic |
$7.00 | n/a | Q:60 /30Days | $1,324.80 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
|
$33.50 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $871.25 |
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)
|
$47.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Harbor Medicare Select (HMO)
|
$47.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $1,374.04 |
Browse Plan Formulary |
Erickson Advantage Freedom (HMO-POS)
|
$49.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | Q:90 /30Days | $1,230.49 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$59.00 |
$0 |
to be determined |
2 |
Generic |
$11.00 | $27.50 | None | $1,305.76 |
Browse Plan Formulary |
McLaren Advantage Diamond (HMO)
|
$63.00 |
$150 |
to be determined |
4 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $1,353.29 |
Browse Plan Formulary |
McLaren Advantage Diamond (HMO)
|
$63.00 |
$150 |
to be determined |
4 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $1,323.75 |
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 |
PriorityMedicare Value (HMO-POS)
|
$66.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | None | $1,274.20 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$79.00 |
$200* |
to be determined |
2* |
Generic |
$15.00 | $37.50 | None | $1,305.76 |
Browse Plan Formulary |
Humana Gold Plus H8908-001 (HMO)
|
$89.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,392.15 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | None | $1,438.36 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | None | $1,286.13 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | None | $1,441.51 |
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 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | None | $1,332.34 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | None | $1,274.20 |
Browse Plan Formulary |
HealthPlus MedicarePlus Option 1 (HMO)
|
$98.00 |
$100* |
to be determined |
5* |
Specialty Tier |
30% | 30% | None | $1,306.15 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
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)
|
$106.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,459.28 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$109.00 |
$100* |
to be determined |
2* |
Generic |
$15.00 | $37.50 | None | $1,305.76 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$121.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $1,392.01 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$126.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $37.50 | None | $1,305.76 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$146.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,274.20 |
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)
|
$154.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,459.28 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
5 |
Specialty Tier |
30% | n/a | None | $1,459.28 |
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)
|
$169.00 |
$100 |
to be determined |
5 |
Specialty Tier |
30% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
5 |
Specialty Tier |
30% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
5 |
Specialty Tier |
30% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
5 |
Specialty Tier |
30% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$190.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | Q:90 /30Days | $1,230.49 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$190.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | Q:90 /30Days | $1,230.49 |
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)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,332.34 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,274.20 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,438.36 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,286.13 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,441.51 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$210.00 |
$150* |
to be determined |
2* |
Generic |
$10.00 | $25.00 | None | $1,305.76 |
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 |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$220.00 |
$50* |
to be determined |
2* |
Generic |
$10.00 | $25.00 | None | $1,305.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,459.28 |
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)
|
$294.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,459.28 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | None | $1,304.94 |
Browse Plan Formulary |