Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE (100 CAPSULE BOTTLE ) (NDC: 00172524160)
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 |
2* |
Generic |
$13.00 | $0.00 | None | $68.82 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$330* |
to be determined |
2* |
Generic |
$12.00 | $0.00 | None | $68.82 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$200* |
to be determined |
2* |
Generic |
$10.00 | $60.00 | None | $48.61 |
Browse Plan Formulary |
Affinity Medicare Passport Essentials NYC (HMO)
|
$0.00 |
$150 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $250.00 | None | $1,005.74 |
Browse Plan Formulary |
AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $101.88 |
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 |
AgeWell New York LiveWell (HMO)
|
$0.00 |
$275 |
to be determined |
2 |
Generic |
$15.00 | $37.50 | None | $101.88 |
Browse Plan Formulary |
AlphaCare Renew (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $130.49 |
Browse Plan Formulary |
AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic Drugs |
0% | 0% | None | $130.49 |
Browse Plan Formulary |
Amida Care True Life Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Generic |
$0.00 | $0.00 | None | $153.90 |
Browse Plan Formulary |
CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,062.27 |
Browse Plan Formulary |
Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $114.86 |
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 |
Centers Plan for Medicare Advantage Care (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Generic |
$2.00 | $5.00 | None | $115.46 |
Browse Plan Formulary |
Elderplan Diabetes Care (HMO SNP)
|
$0.00 |
$360 |
to be determined |
1 |
Preferred Generic |
$5.00 | $12.50 | None | $1,005.52 |
Browse Plan Formulary |
Elderplan FIDA Total Care (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,005.52 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $129.71 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $153.10 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $143.18 |
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 |
EmblemHealth Essential (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $133.53 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $114.78 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $116.96 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $104.45 |
Browse Plan Formulary |
Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | n/a | None | $1,005.74 |
Browse Plan Formulary |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $1,007.45 |
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 |
GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $136.97 |
Browse Plan Formulary |
Healthfirst 65 Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $25.00 | None | $1,005.32 |
Browse Plan Formulary |
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,005.31 |
Browse Plan Formulary |
Humana Gold Plus H3533-017 (HMO)
|
$0.00 |
$360* |
to be determined |
3* |
Preferred Brand |
$47.00 | $131.00 | None | $106.57 |
Browse Plan Formulary |
ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $114.91 |
Browse Plan Formulary |
Liberty Health Advantage Preferred Choice (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $30.00 | None | $83.35 |
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 |
MetroPlus FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,005.76 |
Browse Plan Formulary |
PHP Care Complete FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | n/a | None | $119.33 |
Browse Plan Formulary |
RiverSpring FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $501.55 |
Browse Plan Formulary |
SWH Whole Health FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $188.62 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
|
$0.00 |
$290* |
to be determined |
2* |
Generic |
$12.00 | $0.00 | None | $71.99 |
Browse Plan Formulary |
VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $114.91 |
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 FIDA Complete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $121.62 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
|
$0.00 |
$360 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $121.53 |
Browse Plan Formulary |
WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,005.24 |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
48% | 48% | None | $1,005.24 |
Browse Plan Formulary |
Access Medicare Gold (HMO)
|
$10.00 |
$0 |
to be determined |
2 |
Generic |
$8.00 | $12.00 | None | $105.90 |
Browse Plan Formulary |
WellCare Rx (HMO)
|
$19.00 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $1,005.24 |
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 |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $109.33 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$29.00 |
$230* |
to be determined |
2* |
Generic |
$8.00 | $0.00 | None | $68.82 |
Browse Plan Formulary |
Healthfirst AssuredCare (HMO SNP)
|
$30.80 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,005.32 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
|
$32.50 |
$165 |
to be determined |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $109.33 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$34.30 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $1,005.24 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$35.00 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,005.32 |
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 |
UnitedHealthcare Dual Complete (HMO SNP)
|
$35.90 |
$360 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $72.51 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO SNP)
|
$38.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $1,005.32 |
Browse Plan Formulary |
Healthfirst CompleteCare (HMO SNP)
|
$39.00 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,005.32 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO SNP)
|
$39.00 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $1,005.32 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
|
$39.00 |
$150* |
to be determined |
2* |
Generic |
$8.00 | $0.00 | None | $71.99 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$39.30 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $70.35 |
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 Pearl (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $105.90 |
Browse Plan Formulary |
Access Medicare Pearl Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $105.90 |
Browse Plan Formulary |
Access Medicare Platinum (HMO)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $105.90 |
Browse Plan Formulary |
Access Medicare Platinum Advantage (HMO)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $105.90 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $250.00 | None | $1,005.74 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $1,005.74 |
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 |
AgeWell New York BeWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $101.88 |
Browse Plan Formulary |
AgeWell New York CareWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $101.88 |
Browse Plan Formulary |
AgeWell New York FeelWell (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $101.88 |
Browse Plan Formulary |
AlphaCare Resilience (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $130.49 |
Browse Plan Formulary |
AlphaCare Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $130.49 |
Browse Plan Formulary |
Amida Care Live Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $153.90 |
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 |
Amida Care True Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $153.90 |
Browse Plan Formulary |
ArchCare Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,005.74 |
Browse Plan Formulary |
CenterLight Healthcare Direct Complete Plan (HMO SNP)
|
$39.70 |
$360* |
to be determined |
1* |
Generic |
$9.50 | $28.50 | None | $1,056.52 |
Browse Plan Formulary |
Centers Plan for Dual Coverage Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $114.86 |
Browse Plan Formulary |
Centers Plan for Nursing Home Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $115.46 |
Browse Plan Formulary |
Elderplan Advantage For Nursing Home Residents (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,005.52 |
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 |
Elderplan Extra Help (HMO)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,005.52 |
Browse Plan Formulary |
Elderplan For Medicaid Beneficiaries (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $1,005.52 |
Browse Plan Formulary |
Elderplan Plus Long Term Care (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $1,005.52 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $136.97 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (PPO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $136.97 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
3 |
Preferred Brand |
$45.00 | $135.00 | None | $110.86 |
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 |
Fidelis Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $1,008.05 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $1,007.27 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$16.00 | $32.00 | None | $1,005.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$39.70 |
$250 |
to be determined |
2 |
Generic |
$15.00 | $30.00 | None | $1,007.27 |
Browse Plan Formulary |
GuildNet Gold (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $135.44 |
Browse Plan Formulary |
Liberty Health Advantage Dual Power (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $83.35 |
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 |
RiverSpring Star (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $501.55 |
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 | $188.61 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $121.53 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $121.53 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $121.62 |
Browse Plan Formulary |
Affinity Medicare Passport Select (HMO)
|
$41.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $1,005.74 |
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 Plan 3 (HMO)
|
$69.00 |
$0 |
to be determined |
2 |
Generic |
$8.00 | $0.00 | None | $68.82 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$69.00 |
$200* |
to be determined |
2* |
Generic |
$9.00 | $51.00 | None | $48.61 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
|
$69.00 |
$0 |
to be determined |
2 |
Generic |
$8.00 | $0.00 | None | $71.99 |
Browse Plan Formulary |
Empire MediBlue Access (PPO)
|
$70.00 |
$240 |
to be determined |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $104.73 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$78.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $133.53 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$78.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $129.71 |
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 |
EmblemHealth VIP (HMO)
|
$78.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $153.10 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$78.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $143.18 |
Browse Plan Formulary |
EmblemHealth Advantage (PPO)
|
$88.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $140.42 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Ultra (HMO-POS)
|
$96.40 |
$0 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $121.53 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$115.80 |
$360 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $121.62 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
|
$184.30 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,005.32 |
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 |
2 |
Generic |
$7.00 | $30.00 | None | $74.43 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$290.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $129.71 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$290.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $153.10 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$290.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $143.18 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$290.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $133.53 |
Browse Plan Formulary |