AMLOD-VALSA-HCTZ 10-160-12.5MG [Exforge HCT] (30.000 EA ) (NDC: 68180077206)
2018 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
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 Plan 1 (HMO)
|
$0.00 |
$280 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:30 /30Days | $97.41 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$125* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $34.23 |
Browse Plan Formulary |
Commonwealth Care Alliance (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $178.98 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
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 |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | n/a | None | $49.30 |
Browse Plan Formulary |
Tufts Health Unify (Medicare-Medicaid Plan)
|
$0.00 |
$0 | to be determined | 1 |
Generic Drugs |
0% | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
AARP MedicareComplete Choice (Regional PPO)
|
$19.90 |
$295 | to be determined | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $97.20 |
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 |
UnitedHealthcare Senior Care Options (HMO SNP)
|
$20.30 |
$405 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | n/a | Q:30 /30Days | $97.41 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | Q:1 /1Days | $122.50 |
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 |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$27.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | n/a | Q:30 /30Days | $97.41 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS SNP)
|
$32.80 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$70.00 | $200.00 | Q:30 /30Days | $96.51 |
Browse Plan Formulary |
Aetna Medicare Freedom Plan (PPO)
|
$35.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $34.23 |
Browse Plan Formulary |
NaviCare (HMO SNP)
|
$35.60 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | Q:1 /1Days | $121.11 |
Browse Plan Formulary |
Senior Care Options Program (HMO SNP)
|
$35.60 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | None | $179.10 |
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 Whole Health (HMO SNP)
|
$35.60 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $99.41 |
Browse Plan Formulary |
Senior Whole Health NHC (HMO SNP)
|
$35.60 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $99.41 |
Browse Plan Formulary |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$35.60 |
$405 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | n/a | None | $46.97 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | n/a | None | $52.39 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$43.00 |
$205 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:30 /30Days | $97.41 |
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 |
Erickson Advantage Freedom (HMO-POS)
|
$49.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:30 /30Days | $96.51 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx (HMO)
|
$61.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | None | $129.02 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$66.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$66.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$66.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
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 |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | n/a | None | $46.97 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | n/a | None | $52.39 |
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 |
AARP MedicareComplete Plan 3 (HMO)
|
$77.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:30 /30Days | $97.41 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | n/a | None | $46.97 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | n/a | None | $52.39 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$152.00 |
$300 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$152.00 |
$300 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$152.00 |
$300 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
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 |
Harvard Pilgrim Stride Value Rx Plus (HMO)
|
$157.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | n/a | None | $129.02 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | Q:1 /1Days | $122.50 |
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 |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$189.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$189.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$189.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$196.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:30 /30Days | $96.51 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$196.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:30 /30Days | $96.51 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$221.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$30.00 | n/a | None | $104.56 |
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 |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$221.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$30.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$221.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$30.00 | n/a | None | $104.56 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
|
$262.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | n/a | None | $49.30 |
Browse Plan Formulary |
Medicare HMO Blue PlusRx (HMO)
|
$292.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | n/a | None | $49.30 |
Browse Plan Formulary |