AMANTADINE 50 MG/5 ML SOLUTION (473.000 ML ) (NDC: 00121064616)
2018 Medicare Prescription Drug Plan (MAPD) Information
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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 |
Advantra Silver (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.35 |
Browse Plan Formulary |
Aetna Medicare PinnacleHealth Prime Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.44 |
Browse Plan Formulary |
BlueJourney Essential (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | $45.00 | None | $16.86 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:1240 /31Days | $18.46 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:1240 /31Days | $19.36 |
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 |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:1240 /31Days | $20.26 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
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 |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
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 |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Humana Gold Plus H6622-035 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $10.53 |
Browse Plan Formulary |
Humana Gold Plus H6622-043 (HMO)
|
$0.00 |
$300 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $10.53 |
Browse Plan Formulary |
Vibra Health Plan Essential Coverage (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | n/a | None | $23.85 |
Browse Plan Formulary |
AdvantraOne (PPO)
|
$19.00 |
$195 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.25 |
Browse Plan Formulary |
UPMC for Life HMO Deductible with Rx (HMO)
|
$20.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | n/a | None | $26.22 |
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 SNP-DE H6622-038 (HMO SNP)
|
$25.00 |
$230 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $10.53 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$27.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:1240 /31Days | $20.54 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$27.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:1240 /31Days | $18.65 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$27.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:1240 /31Days | $18.46 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO SNP)
|
$29.30 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$12.00 | $0.00 | None | $32.26 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.40 |
$315 | to be determined | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $10.53 |
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 |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$32.70 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | n/a | None | $33.06 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$35.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | n/a | None | $26.22 |
Browse Plan Formulary |
Advantra Silver Plus (HMO)
|
$36.00 |
$95 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.35 |
Browse Plan Formulary |
HumanaChoice H5525-006 (PPO)
|
$37.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $10.53 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO SNP)
|
$37.20 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | None | $10.37 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO SNP)
|
$37.20 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $10.37 |
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 |
Geisinger Gold Secure Rx (HMO SNP)
|
$37.20 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
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 |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
BlueJourney Value (HMO)
|
$48.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$12.00 | $36.00 | None | $16.86 |
Browse Plan Formulary |
Vibra Health Plan Enhanced Coverage (PPO)
|
$55.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | n/a | None | $23.85 |
Browse Plan Formulary |
Aetna Medicare Silver Plan (HMO)
|
$56.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.30 |
Browse Plan Formulary |
BlueJourney Classic (PPO)
|
$62.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | $45.00 | None | $16.86 |
Browse Plan Formulary |
Humana Gold Choice H8145-052 (PFFS)
|
$63.00 |
$360* | No additional gap coverage, only the Donut Hole Discount | 3* |
Preferred Brand |
$47.00 | $131.00 | None | $10.53 |
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 |
Freedom Blue PPO ValueRx (PPO)
|
$73.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | $40.00 | Q:1240 /31Days | $19.88 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
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 |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$81.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | n/a | None | $26.22 |
Browse Plan Formulary |
Advantra Silver Plus (PPO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.44 |
Browse Plan Formulary |
HumanaChoice H5216-120 (PPO)
|
$117.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $10.53 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.25 |
Browse Plan Formulary |
BlueJourney Premier (HMO)
|
$148.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | $30.00 | None | $16.86 |
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 |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | n/a | None | $12.97 |
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 |
Aetna Medicare Gold Plan (PPO)
|
$156.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $11.30 |
Browse Plan Formulary |
BlueJourney Prime (PPO)
|
$169.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | $45.00 | None | $16.86 |
Browse Plan Formulary |
Freedom Blue PPO Standard (PPO)
|
$188.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | $40.00 | Q:1240 /31Days | $19.88 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$291.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $40.00 | Q:1240 /31Days | $19.88 |
Browse Plan Formulary |