DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT (100 BOT) (NDC: 00378641001)
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 |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$11.00 | $33.00 | P | $47.37 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$11.00 | $33.00 | P | $45.65 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$11.00 | $33.00 | P | $45.28 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | P | $47.02 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | P | $45.31 |
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 Basic (HMO-POS)
|
$0.00 |
$395 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | P | $46.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | P | $46.65 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | P | $44.92 |
Browse Plan Formulary |
HAP Senior Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | n/a | None | $47.11 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | n/a | None | $40.35 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | n/a | None | $38.24 |
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 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | n/a | None | $37.84 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | n/a | None | $42.80 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | n/a | None | $43.47 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (PPO)
|
$15.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | n/a | None | $47.11 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | n/a | None | $43.47 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | n/a | None | $42.80 |
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 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | n/a | None | $37.84 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | n/a | None | $38.24 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | n/a | None | $40.35 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
|
$20.00 |
$405 | to be determined | 4 |
Non-Preferred Drug |
25% | 25% | P | $36.77 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$11.00 | $33.00 | P | $47.37 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$11.00 | $33.00 | P | $45.28 |
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)
|
$23.00 |
$100* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$11.00 | $33.00 | P | $45.65 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$29.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $47.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$29.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $45.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$29.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $44.92 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$29.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $46.37 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$29.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $46.88 |
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 |
HAP Senior Plus Option 1 (HMO-POS)
|
$45.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | n/a | None | $47.11 |
Browse Plan Formulary |
BCN Advantage HMO ConnectedCare (HMO)
|
$56.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $30.00 | P | $45.28 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$63.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | n/a | None | $40.35 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (HMO-POS)
|
$85.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | n/a | None | $47.11 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$86.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | n/a | None | $43.47 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$86.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | n/a | None | $37.84 |
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 Merit (PPO)
|
$86.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | n/a | None | $38.24 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$86.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | n/a | None | $40.35 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$86.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | n/a | None | $42.80 |
Browse Plan Formulary |
Humana Gold Choice H8145-006 (PFFS)
|
$97.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | P | $36.77 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$104.50 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $45.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$104.50 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $46.88 |
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)
|
$104.50 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $44.92 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$104.50 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $46.37 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$104.50 |
$405 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$11.00 | $33.00 | None | $47.58 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (PPO)
|
$118.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$15.00 | n/a | None | $47.11 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$140.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$8.00 | n/a | None | $40.35 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $47.02 |
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)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $45.31 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $46.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $46.65 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $44.92 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (HMO-POS)
|
$170.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | n/a | None | $47.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$179.50 |
$105* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $30.00 | None | $44.92 |
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)
|
$179.50 |
$105* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $30.00 | None | $46.37 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$179.50 |
$105* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $30.00 | None | $46.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$179.50 |
$105* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $30.00 | None | $45.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$179.50 |
$105* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $30.00 | None | $47.58 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
|
$190.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | n/a | None | $47.11 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$198.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | n/a | None | $43.47 |
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)
|
$198.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | n/a | None | $42.80 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$198.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | n/a | None | $37.84 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$198.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | n/a | None | $38.24 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$198.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | n/a | None | $40.35 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$301.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $47.02 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$301.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $45.31 |
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)
|
$301.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $46.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$301.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $46.65 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$301.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $21.00 | P | $44.92 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$312.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | None | $44.92 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$312.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | None | $46.37 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$312.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | None | $46.88 |
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 Assure (PPO)
|
$312.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | None | $45.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$312.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$9.00 | $27.00 | None | $47.58 |
Browse Plan Formulary |