Methylergonovine Maleate 0.2mg/1 28 TABLET BOTTLE (28 TABLET in 1 BOTTLE ) (NDC: 43386014028)
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 |
4 |
Non-Preferred Brand |
$93.00 | $269.00 | None | $1,705.39 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$330 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $1,705.39 |
Browse Plan Formulary |
Advantage Health NYC - SNP (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $2,049.10 |
Browse Plan Formulary |
Advantage Silver - NY City (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $2,049.10 |
Browse Plan Formulary |
Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,830.27 |
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 |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$160 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $537.49 |
Browse Plan Formulary |
Affinity Medicare Passport Essentials NYC (HMO)
|
$0.00 |
$150 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $250.00 | None | $1,830.28 |
Browse Plan Formulary |
AlphaCare Renew (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | None | $2,041.45 |
Browse Plan Formulary |
AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand Drugs |
0% | 0% | None | $2,041.45 |
Browse Plan Formulary |
Amida Care True Life Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Generic |
$0.00 | $0.00 | None | $1,746.70 |
Browse Plan Formulary |
CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | Q:28 /180Days | $1,990.54 |
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 |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None | $2,002.91 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None | $1,612.05 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$0.00 |
$245 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None | $1,907.78 |
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 | $1,830.28 |
Browse Plan Formulary |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $1,830.28 |
Browse Plan Formulary |
GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,723.69 |
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 |
Healthfirst 65 Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $25.00 | None | $1,829.85 |
Browse Plan Formulary |
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,829.85 |
Browse Plan Formulary |
Humana Gold Plus H3533-005 (HMO)
|
$0.00 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $1,768.03 |
Browse Plan Formulary |
MetroPlus FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,830.30 |
Browse Plan Formulary |
North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,830.27 |
Browse Plan Formulary |
RiverSpring FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $721.03 |
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 |
1 |
Generic Drugs |
0% | 0% | None | $1,769.83 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
|
$0.00 |
$290 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $1,701.38 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
|
$0.00 |
$360 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $1,781.38 |
Browse Plan Formulary |
WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $1,829.78 |
Browse Plan Formulary |
Access Medicare Gold (HMO)
|
$10.00 |
$0 |
to be determined |
2 |
Generic |
$8.00 | $12.00 | None | $2,060.97 |
Browse Plan Formulary |
Humana Gold Plus H3533-021 (HMO)
|
$24.10 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $1,764.26 |
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 1 (HMO)
|
$29.00 |
$230 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $1,705.39 |
Browse Plan Formulary |
Healthfirst AssuredCare (HMO SNP)
|
$30.80 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,829.85 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,735.61 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,707.26 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,671.59 |
Browse Plan Formulary |
EmblemHealth Essential (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,738.81 |
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 |
Humana Gold Plus SNP-DE H3533-004 (HMO SNP)
|
$32.50 |
$165 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $1,764.26 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$35.00 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,829.85 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$35.90 |
$360 |
to be determined |
4 |
Tier 4 |
$0.00 | $0.00 | None | $1,701.45 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO SNP)
|
$38.70 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $1,829.85 |
Browse Plan Formulary |
Healthfirst CompleteCare (HMO SNP)
|
$39.00 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,829.85 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO SNP)
|
$39.00 |
$360 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $1,829.85 |
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 |
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
|
$39.00 |
$150 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $1,701.38 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$39.30 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,703.86 |
Browse Plan Formulary |
Access Medicare Pearl (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $2,060.97 |
Browse Plan Formulary |
Access Medicare Pearl Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $2,060.97 |
Browse Plan Formulary |
Access Medicare Platinum (HMO)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,060.97 |
Browse Plan Formulary |
Access Medicare Platinum Advantage (HMO)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,060.97 |
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 |
Advantage Value One NY - Dual (HMO SNP)
|
$39.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $2,035.92 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $250.00 | None | $1,830.28 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None | $1,830.28 |
Browse Plan Formulary |
AlphaCare Resilience (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,041.45 |
Browse Plan Formulary |
AlphaCare Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
5 |
Tier 5 |
15% | 15% | None | $2,041.45 |
Browse Plan Formulary |
Amida Care Live Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $1,746.70 |
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 |
Amida Care True Life Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,746.70 |
Browse Plan Formulary |
ArchCare Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,830.28 |
Browse Plan Formulary |
CenterLight Healthcare Direct Complete Plan (HMO SNP)
|
$39.70 |
$360* |
to be determined |
1* |
Generic |
$9.50 | $28.50 | Q:28 /180Days | $1,957.71 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $1,723.69 |
Browse Plan Formulary |
EmblemHealth Dual Eligible (PPO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $1,723.69 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$94.00 | $282.00 | None | $1,875.49 |
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 |
Fidelis Dual Advantage (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $1,830.28 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$20.00 | $40.00 | None | $1,830.28 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$16.00 | $32.00 | None | $1,830.28 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$39.70 |
$250 |
to be determined |
2 |
Generic |
$15.00 | $30.00 | None | $1,830.28 |
Browse Plan Formulary |
GuildNet Gold (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $1,729.78 |
Browse Plan Formulary |
RiverSpring Star (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $718.31 |
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 |
Senior Whole Health of New York NHC (HMO SNP)
|
$39.70 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,769.82 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,781.38 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,781.38 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$39.70 |
$360 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $1,781.38 |
Browse Plan Formulary |
Affinity Medicare Passport Select (HMO)
|
$41.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $1,830.28 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$69.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $1,705.39 |
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 MedicareComplete Choice Plan 4 (Regional PPO)
|
$69.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $1,701.38 |
Browse Plan Formulary |
Advantage Platinum Plus NY (HMO)
|
$85.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $2,035.92 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$96.00 |
$150 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $545.70 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Ultra (HMO-POS)
|
$96.40 |
$0 |
to be determined |
2 |
Generic |
$9.00 | $27.00 | None | $1,781.38 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,738.81 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,735.61 |
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)
|
$103.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,707.26 |
Browse Plan Formulary |
EmblemHealth VIP (HMO)
|
$103.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,671.59 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$115.80 |
$360 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $1,781.38 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
|
$184.30 |
$360 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,829.85 |
Browse Plan Formulary |
Aetna Medicare Connect Plus (PPO)
|
$188.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
50% | 50% | None | $634.11 |
Browse Plan Formulary |
EmblemHealth Advantage (PPO)
|
$223.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,732.93 |
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 High Option (HMO)
|
$306.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,735.61 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,707.26 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,671.59 |
Browse Plan Formulary |
EmblemHealth VIP High Option (HMO)
|
$306.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $45.00 | None | $1,738.81 |
Browse Plan Formulary |