NICARDIPINE HYDROCHLORIDE 20MG CAPSULES (90 BOT ) (NDC: 00378102077)
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 | 3 |
Tier 3 |
$47.00 | $131.00 | None | $134.96 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$47.00 | $131.00 | None | $134.96 |
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 | None | $114.05 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | $10.00 | None | $143.36 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | $10.00 | None | $143.71 |
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. | 2 |
Generic |
$5.00 | $10.00 | None | $143.36 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | $20.00 | None | $143.36 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$15.00 | n/a | None | $77.99 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$12.00 | n/a | None | $39.45 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | n/a | None | $79.69 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$3.00 | n/a | None | $79.69 |
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 |
Bridges Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.00 | n/a | None | $143.20 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | n/a | None | $134.46 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.50 | n/a | None | $141.25 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.50 | n/a | None | $141.25 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.50 | n/a | None | $141.25 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.50 | n/a | None | $141.25 |
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 StartSmart Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$14.50 | n/a | None | $141.25 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.50 | n/a | None | $141.25 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.50 | n/a | None | $141.25 |
Browse Plan Formulary |
Central Health Focus Plan (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | n/a | None | $141.25 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | n/a | None | $141.25 |
Browse Plan Formulary |
Classic Care (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | n/a | None | $143.20 |
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 |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $37.50 | None | $150.98 |
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 | $151.46 |
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 | $151.46 |
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 | $151.46 |
Browse Plan Formulary |
Healthy Heart Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.00 | n/a | None | $143.20 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$2.00 | n/a | None | $161.34 |
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 |
Hope Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.00 | n/a | None | $143.20 |
Browse Plan Formulary |
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 | None | $98.27 |
Browse Plan Formulary |
In Control Drug Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$9.00 | n/a | None | $143.20 |
Browse Plan Formulary |
Inter Valley Health Plan OC Preferred (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | n/a | None | $141.25 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$12.00 | n/a | None | $141.25 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | n/a | None | $106.20 |
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 Connect (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $145.06 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$2.00 | n/a | None | $158.76 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | n/a | None | $161.34 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | n/a | None | $159.17 |
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 | None | $142.99 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$5.80 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | n/a | None | $106.20 |
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 H5619-037 (HMO)
|
$16.50 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $98.27 |
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 | $151.46 |
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 | $151.46 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$26.70 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | n/a | None | $137.30 |
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 | None | $113.83 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$27.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$20.00 | $50.00 | None | $150.98 |
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 Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$20.00 | n/a | None | $106.20 |
Browse Plan Formulary |
OneCare (HMO SNP)
|
$33.50 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic |
$0.00 | n/a | None | $145.06 |
Browse Plan Formulary |
CareMore Connect Plus (HMO)
|
$36.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | n/a | None | $141.25 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$36.20 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | n/a | None | $128.90 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$36.20 |
$400* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$0.00 | n/a | None | $141.25 |
Browse Plan Formulary |
Coordinated Choice Plan (HMO)
|
$36.20 |
$400 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
25% | n/a | None | $136.93 |
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 |
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 | $134.91 |
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 | $134.91 |
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 | $134.91 |
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 | $134.91 |
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 | $134.91 |
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 | $134.91 |
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 Sapphire (HMO)
|
$36.20 |
$140 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | $290.00 | None | $134.91 |
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 | $134.91 |
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 | None | $141.25 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $143.53 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$10.00 | n/a | None | $77.99 |
Browse Plan Formulary |
Bridges - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $143.20 |
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 |
Classic Choice for Medi-Medi (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $143.20 |
Browse Plan Formulary |
Dual Coverage (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $143.20 |
Browse Plan Formulary |
Harmony - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $143.20 |
Browse Plan Formulary |
Healthy Heart - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $143.20 |
Browse Plan Formulary |
In Control - Dual Access (HMO SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $143.20 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $161.34 |
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 |
VillageHealth (HMO-POS SNP)
|
$36.30 |
$400 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $158.76 |
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 | None | $114.05 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$150.00 |
$230 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | n/a | None | $39.45 |
Browse Plan Formulary |