HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD (10 X 1 ML VIALSD) (NDC: 58160082611)
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 |
$280 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $143.50 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$125 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | None | $138.45 |
Browse Plan Formulary |
Commonwealth Care Alliance (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Preferred Brand Drugs |
0% | n/a | None | $144.51 |
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 | None | $138.75 |
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 | None | $139.15 |
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 | None | $138.58 |
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 | None | $138.20 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.83 |
Browse Plan Formulary |
Tufts Health Unify (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | n/a | None | $136.75 |
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 | $136.76 |
Browse Plan Formulary |
AARP MedicareComplete Choice (Regional PPO)
|
$19.90 |
$295 |
to be determined |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $143.68 |
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 |
3 |
Tier 3 |
$0.00 | n/a | None | $142.73 |
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 | None | $138.58 |
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 | None | $138.20 |
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 | None | $138.75 |
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 | None | $138.07 |
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 | None | $139.15 |
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 | None | $137.94 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$27.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | n/a | None | $142.73 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS SNP)
|
$32.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$28.00 | $74.00 | None | $143.80 |
Browse Plan Formulary |
Aetna Medicare Freedom Plan (PPO)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | None | $138.45 |
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 | None | $137.14 |
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 | $144.52 |
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 | $133.38 |
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 | $133.38 |
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 | $136.75 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.39 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.94 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$43.00 |
$205 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $143.50 |
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 |
Erickson Advantage Freedom (HMO-POS)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $143.80 |
Browse Plan Formulary |
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 | None | $133.18 |
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 | $136.46 |
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 | $136.83 |
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 | $136.73 |
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 | None | $138.07 |
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 | None | $139.15 |
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 | None | $138.58 |
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 | None | $137.94 |
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 | None | $138.75 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.39 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.94 |
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 |
AARP MedicareComplete Plan 3 (HMO)
|
$77.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $143.50 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.39 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.94 |
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 | $136.46 |
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 | $136.83 |
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 | $136.73 |
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. |
4 |
Non-Preferred Brand |
$100.00 | n/a | None | $132.95 |
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 | None | $139.15 |
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 | None | $138.58 |
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 | None | $137.94 |
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 | None | $138.20 |
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 | None | $138.07 |
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 | $136.83 |
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 | $136.73 |
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 | $136.46 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$196.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $143.80 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$196.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $143.80 |
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 | $136.73 |
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 | $136.46 |
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 | $136.83 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
|
$262.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.83 |
Browse Plan Formulary |
Medicare HMO Blue PlusRx (HMO)
|
$292.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | None | $134.83 |
Browse Plan Formulary |