SAPHRIS 2.5 MG TAB SL BLK CHRY (60 EA ) (NDC: 00456240260)
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 |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
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 |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P Q:60 /30Days | $2,090.48 |
Browse Plan Formulary |
HealthPlus MedicarePlus Option 0 (HMO)
|
$0.00 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:60 /30Days | $2,080.46 |
Browse Plan Formulary |
Meridian Prime (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$47.00 | $94.00 | None | $2,083.80 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
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 |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
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 |
PriorityMedicare Ideal (PPO)
|
$15.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$20.50 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
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 |
3 |
Non-Preferred Brand |
$85.00 | $191.25 | P Q:60 /30Days | $2,058.39 |
Browse Plan Formulary |
McLaren Advantage Sapphire (HMO)
|
$29.00 |
$150 |
to be determined |
3 |
Non-Preferred Brand |
$85.00 | $191.25 | P Q:60 /30Days | $2,058.39 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS SNP)
|
$29.10 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$70.00 | $200.00 | Q:60 /30Days | $2,084.49 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$33.00 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:240 /30Days | $2,154.42 |
Browse Plan Formulary |
HAP Midwest Health Plan (HMO SNP)
|
$33.50 |
$360 |
to be determined |
2 |
Brand |
25% | n/a | P Q:60 /30Days | $2,081.45 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
|
$33.50 |
$360 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,083.80 |
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 |
4 |
Non-Preferred Brand |
$100.00 | $250.00 | S | $2,110.36 |
Browse Plan Formulary |
Harbor Medicare Select (HMO)
|
$47.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P Q:60 /30Days | $2,090.48 |
Browse Plan Formulary |
Erickson Advantage Freedom (HMO-POS)
|
$49.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | Q:60 /30Days | $2,084.49 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$59.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
23% | 23% | P | $2,047.08 |
Browse Plan Formulary |
McLaren Advantage Diamond (HMO)
|
$63.00 |
$150 |
to be determined |
3 |
Non-Preferred Brand |
$85.00 | $191.25 | P Q:60 /30Days | $2,058.39 |
Browse Plan Formulary |
McLaren Advantage Diamond (HMO)
|
$63.00 |
$150 |
to be determined |
3 |
Non-Preferred Brand |
$85.00 | $191.25 | P Q:60 /30Days | $2,058.39 |
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 |
PriorityMedicare Value (HMO-POS)
|
$66.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$79.00 |
$200 |
to be determined |
4 |
Non-Preferred Brand |
28% | 28% | P | $2,047.08 |
Browse Plan Formulary |
Humana Gold Plus H8908-001 (HMO)
|
$89.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | n/a | P Q:60 /30Days | $2,067.87 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $2,098.13 |
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 |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$95.00 |
$75 |
to be determined |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
HealthPlus MedicarePlus Option 1 (HMO)
|
$98.00 |
$100 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $250.00 | S Q:60 /30Days | $2,080.46 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
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 |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$106.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | S | $2,110.36 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$109.00 |
$100 |
to be determined |
4 |
Non-Preferred Brand |
28% | 28% | P | $2,047.08 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$121.00 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:60 /30Days | $2,067.87 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$126.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
33% | 33% | P | $2,047.08 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$146.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $2,098.13 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$154.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
4 |
Non-Preferred Brand |
$98.00 | $245.00 | S | $2,110.36 |
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 |
4 |
Non-Preferred Brand |
$98.00 | $245.00 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
4 |
Non-Preferred Brand |
$98.00 | $245.00 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
4 |
Non-Preferred Brand |
$98.00 | $245.00 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$169.00 |
$100 |
to be determined |
4 |
Non-Preferred Brand |
$98.00 | $245.00 | S | $2,110.36 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$190.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | Q:60 /30Days | $2,084.49 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$190.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | Q:60 /30Days | $2,084.49 |
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 | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$193.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $2,098.13 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$210.00 |
$150 |
to be determined |
4 |
Non-Preferred Brand |
29% | 29% | P | $2,047.08 |
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 |
4 |
Non-Preferred Brand |
31% | 31% | P | $2,047.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | S | $2,110.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$283.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | S | $2,110.36 |
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 |
4 |
Non-Preferred Brand |
$97.00 | $242.50 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$97.00 | $242.50 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$97.00 | $242.50 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$97.00 | $242.50 | S | $2,110.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$294.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$97.00 | $242.50 | S | $2,110.36 |
Browse Plan Formulary |