FANAPT 4 MG TABLET (60 EA ) (NDC: 43068010402)
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 |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$235 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | S Q:60 /30Days | $1,113.16 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$125 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $1,111.52 |
Browse Plan Formulary |
Commonwealth Care Alliance (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Non-Preferred Brand Drugs |
0% | n/a | P Q:60 /30Days | $1,177.03 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,106.36 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,182.43 |
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 |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,115.17 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,122.71 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,061.94 |
Browse Plan Formulary |
Tufts Health Unify (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | n/a | S | $1,099.21 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,099.21 |
Browse Plan Formulary |
AARP MedicareComplete Choice (Regional PPO)
|
$19.90 |
$295 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:60 /30Days | $1,142.98 |
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 |
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 | S Q:60 /30Days | $1,114.67 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,115.17 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,182.43 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,122.71 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,106.36 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$24.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,182.43 |
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 |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,182.43 |
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 | S Q:60 /30Days | $1,114.67 |
Browse Plan Formulary |
Aetna Medicare Freedom Plan (PPO)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $1,111.52 |
Browse Plan Formulary |
BMC HealthNet Plan Senior Care Options (HMO SNP)
|
$35.60 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | S | $1,151.87 |
Browse Plan Formulary |
NaviCare (HMO SNP)
|
$35.60 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | n/a | P | $1,102.16 |
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 | P Q:60 /30Days | $1,180.99 |
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 | Q:180 /30Days | $1,062.05 |
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 | Q:180 /30Days | $1,062.05 |
Browse Plan Formulary |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$35.60 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | n/a | S | $1,099.21 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,061.94 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,110.75 |
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 | S Q:60 /30Days | $1,113.16 |
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 (HMO)
|
$61.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | S | $1,068.96 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$66.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,186.90 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$66.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,098.90 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$66.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,099.40 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,182.43 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,182.43 |
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 |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,115.17 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,182.43 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced RX (HMO)
|
$72.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,122.71 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,110.75 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,061.94 |
Browse Plan Formulary |
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 | S Q:60 /30Days | $1,113.16 |
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 HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,110.75 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,061.94 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$152.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,186.90 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$152.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,098.90 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$152.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,099.40 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx Plus (HMO)
|
$157.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$100.00 | n/a | S | $1,068.96 |
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 Plus Enhanced RX (HMO)
|
$172.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,182.43 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,115.17 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,122.71 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,182.43 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced RX (HMO)
|
$172.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $258.00 | P | $1,106.36 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$189.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,098.90 |
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 |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,099.40 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$189.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | n/a | S | $1,186.90 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$221.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$80.00 | n/a | S | $1,099.40 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$221.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$80.00 | n/a | S | $1,186.90 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$221.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$80.00 | n/a | S | $1,098.90 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
|
$262.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,061.94 |
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 HMO Blue PlusRx (HMO)
|
$292.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,061.94 |
Browse Plan Formulary |