AVONEX ADMIN PACK 30 MCG VL (4 EA ) (NDC: 59627011103)
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 | 5 |
Specialty Tier |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $6,122.84 |
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 | 5 |
Tier 5 |
25% | n/a | None | $6,488.78 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,360.11 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,157.17 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,171.36 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,269.79 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$12.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | None | $6,488.75 |
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 HealthySaver (HMO)
|
$18.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$18.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$18.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | P | $6,443.39 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,269.79 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,488.78 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,360.11 |
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 |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,157.17 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | None | $6,171.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$21.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
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 | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$25.50 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $6,178.20 |
Browse Plan Formulary |
BCN Advantage HMO MyChoice Wellness (HMO)
|
$37.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO MyChoice Wellness (HMO)
|
$37.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,443.39 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | None | $6,157.14 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | None | $6,310.09 |
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 | 5 |
Specialty Tier |
31% | n/a | None | $6,488.75 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | None | $6,269.55 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | None | $6,172.39 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
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 | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$46.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P | $6,122.84 |
Browse Plan Formulary |
HumanaChoice H5216-009 (PPO)
|
$69.00 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $6,205.58 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$90.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $6,488.75 |
Browse Plan Formulary |
Humana Gold Choice H8145-006 (PFFS)
|
$97.00 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $6,176.50 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
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 | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$115.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | n/a | P | $6,122.84 |
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 | 5 |
Specialty Tier |
30% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$131.00 |
$105 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | n/a | P | $6,122.84 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $6,488.75 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $6,310.09 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $6,157.14 |
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 Select (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $6,172.39 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $6,269.55 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$202.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
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 | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$211.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $6,122.84 |
Browse Plan Formulary |