LEVOXYL 88 MCG TABLET (100.000 EA ) (NDC: 60793085301)
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 |
Aetna Better Health Premier Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | None | $13.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $9.00 | None | $23.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $9.00 | None | $23.82 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $9.00 | None | $24.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $9.00 | None | $25.02 |
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 Basic (HMO-POS)
|
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $9.00 | None | $25.44 |
Browse Plan Formulary |
MeridianCare Essential (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | n/a | None | $26.95 |
Browse Plan Formulary |
MeridianComplete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | n/a | None | $26.98 |
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 | $24.51 |
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 | $21.93 |
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 | $23.17 |
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 | $23.43 |
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 | $25.39 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$9.00 |
$75 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | n/a | None | $21.93 |
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 | $25.39 |
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 | $24.51 |
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 | $21.93 |
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 | $23.17 |
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 | $23.43 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$19.50 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $23.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$19.50 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $25.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$19.50 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $25.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$19.50 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $23.82 |
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 Essential (PPO)
|
$19.50 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $25.37 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
|
$20.00 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | 25% | None | $26.31 |
Browse Plan Formulary |
MeridianCare Extra (HMO SNP)
|
$33.30 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | None | $26.95 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $25.39 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $24.51 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $21.93 |
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)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $23.17 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | None | $23.43 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$44.00 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $25.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$44.00 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $25.37 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$44.00 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $23.82 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$44.00 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $23.71 |
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)
|
$44.00 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $25.02 |
Browse Plan Formulary |
HumanaChoice H5216-009 (PPO)
|
$75.00 |
$105 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $26.31 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$90.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | n/a | None | $21.93 |
Browse Plan Formulary |
Humana Gold Choice H8145-006 (PFFS)
|
$97.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $26.31 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $25.02 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $25.44 |
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)
|
$113.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $23.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $23.82 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $24.75 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $23.43 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $25.39 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $24.51 |
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)
|
$129.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $21.93 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | n/a | None | $23.17 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$129.50 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $3.00 | None | $25.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$129.50 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $3.00 | None | $25.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$129.50 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $3.00 | None | $25.37 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$129.50 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $3.00 | None | $23.82 |
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)
|
$129.50 |
$105* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $3.00 | None | $23.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $25.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $23.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $23.82 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $24.75 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $25.02 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$209.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $25.37 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$209.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $23.82 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$209.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $23.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$209.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $25.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$209.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$1.00 | $3.00 | None | $25.40 |
Browse Plan Formulary |