NEUPRO 8 MG/24 HR PATCH (30 EA ) (NDC: 50474080603)
2017 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 SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$100.00 | $290.00 | None | $622.57 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$100.00 | $290.00 | None | $622.57 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $632.18 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$30.00 | $60.00 | None | $628.32 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$30.00 | $60.00 | None | $628.39 |
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 |
Alignment Health Plan Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$30.00 | $60.00 | None | $628.32 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$30.00 | $60.00 | None | $628.32 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$42.00 | n/a | Q:30 /30Days | $620.46 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$42.00 | n/a | Q:30 /30Days | $619.76 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$88.00 | n/a | Q:30 /30Days | $616.40 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$65.00 | n/a | Q:30 /30Days | $616.40 |
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 |
Bridges Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | n/a | P Q:30 /30Days | $643.15 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | n/a | P Q:30 /30Days | $643.15 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | n/a | P Q:30 /30Days | $643.15 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | n/a | P Q:30 /30Days | $643.15 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | n/a | P Q:30 /30Days | $643.15 |
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 |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | n/a | P Q:30 /30Days | $643.15 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | n/a | P Q:30 /30Days | $643.15 |
Browse Plan Formulary |
Central Health Focus Plan (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$75.00 | n/a | Q:30 /30Days | $633.95 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$75.00 | n/a | Q:30 /30Days | $633.95 |
Browse Plan Formulary |
Classic Care (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$99.00 | $247.50 | None | $633.97 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | None | $636.39 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | None | $635.99 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | None | $636.44 |
Browse Plan Formulary |
Healthy Heart Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | n/a | Q:30 /30Days | $623.90 |
Browse Plan Formulary |
Hope Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $609.96 |
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 H5619-021 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:30 /30Days | $621.05 |
Browse Plan Formulary |
In Control Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
Inter Valley Health Plan OC Preferred (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$89.00 | n/a | Q:30 /30Days | $643.15 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | n/a | Q:30 /30Days | $643.15 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $693.97 |
Browse Plan Formulary |
OneCare Connect (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Brand Drugs |
0% | n/a | P Q:30 /30Days | $651.11 |
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 |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | n/a | Q:30 /30Days | $624.62 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | n/a | Q:30 /30Days | $623.90 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | n/a | Q:30 /30Days | $623.96 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$4.40 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | S | $620.54 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$5.80 |
$0 | to be determined | 4 |
Tier 4 |
$95.00 | n/a | None | $684.43 |
Browse Plan Formulary |
Humana Gold Plus H5619-037 (HMO)
|
$16.50 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $621.14 |
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 |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | None | $635.99 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | None | $636.39 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$26.70 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | n/a | None | $622.81 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$27.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $631.74 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$27.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$99.00 | $247.50 | None | $633.97 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $684.43 |
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 |
OneCare (HMO SNP)
|
$33.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Tier 2 |
$0.00 | n/a | P Q:30 /30Days | $651.11 |
Browse Plan Formulary |
CareMore Connect Plus (HMO)
|
$36.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | n/a | P Q:30 /30Days | $643.15 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$36.20 |
$400 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
25% | n/a | Q:30 /30Days | $633.95 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$36.20 |
$175 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $633.99 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$36.20 |
$155 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $633.90 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$36.20 |
$155 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $634.62 |
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 |
Health Net Seniority Plus Amber II (HMO SNP)
|
$36.20 |
$155 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $632.96 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$36.20 |
$140 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $632.96 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$36.20 |
$140 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $634.55 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$36.20 |
$140 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $634.00 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$36.20 |
$170 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $633.90 |
Browse Plan Formulary |
Inter Valley Health Plan Value Preferred Choice (HMO)
|
$36.20 |
$400 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | Q:30 /30Days | $643.15 |
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 |
Alignment Health Plan CalPlus (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $629.67 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$47.00 | n/a | Q:30 /30Days | $620.46 |
Browse Plan Formulary |
Bridges - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
Classic Choice for Medi-Medi (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
Dual Coverage (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
Harmony - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $609.96 |
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 |
Healthy Heart - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
In Control - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $609.96 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | n/a | Q:30 /30Days | $623.90 |
Browse Plan Formulary |
VillageHealth (HMO-POS SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | n/a | Q:30 /30Days | $624.62 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $632.18 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$150.00 |
$230 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | n/a | Q:30 /30Days | $619.76 |
Browse Plan Formulary |