ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT (16 FLO BOT) (NDC: 50383074016)
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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
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 Key (HMO-POS)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $39.15 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $36.02 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $44.68 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $49.41 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $39.43 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$12.00 |
$75 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | n/a | None | $49.34 |
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 |
BCN Advantage HMO HealthySaver (HMO)
|
$18.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$18.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$18.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | n/a | None | $7.75 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $49.41 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $39.43 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $39.15 |
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 |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $36.02 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $44.68 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
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 |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$25.50 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | 25% | None | $24.72 |
Browse Plan Formulary |
BCN Advantage HMO MyChoice Wellness (HMO)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO MyChoice Wellness (HMO)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $42.53 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $44.14 |
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 |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $36.01 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $45.66 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $49.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $7.75 |
Browse Plan Formulary |
HumanaChoice H5216-009 (PPO)
|
$69.00 |
$400* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | None | $24.72 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$90.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | n/a | None | $49.34 |
Browse Plan Formulary |
Humana Gold Choice H8145-006 (PFFS)
|
$97.00 |
$400* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | None | $24.72 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $45.66 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $42.53 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $49.34 |
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 Select (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $44.14 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $36.01 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | n/a | None | $7.75 |
Browse Plan Formulary |