LISINOPRIL-HCTZ 20-12.5 MG TAB (500.000 EA ) (NDC: 68180051902)
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 |
Advantage Health LI - SNP (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | n/a | None | $2.66 |
Browse Plan Formulary |
Advantage Silver - NY (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | n/a | None | $2.66 |
Browse Plan Formulary |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $7.24 |
Browse Plan Formulary |
Affinity Medicare Passport Essentials (HMO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$0.00 | n/a | None | $1.34 |
Browse Plan Formulary |
AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $4.05 |
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 |
AgeWell New York LiveWell (HMO)
|
$0.00 |
$225* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$5.00 | n/a | None | $4.86 |
Browse Plan Formulary |
AgeWell New York LiveWell (HMO)
|
$0.00 |
$225* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$5.00 | n/a | None | $3.90 |
Browse Plan Formulary |
Centers Plan for Medicare Advantage Care (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$3.00 | n/a | None | $4.57 |
Browse Plan Formulary |
Elderplan FIDA Total Care (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $2.19 |
Browse Plan Formulary |
EmblemHealth VIP Value (HMO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.45 |
Browse Plan Formulary |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | n/a | None | $1.61 |
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 |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | n/a | None | $1.59 |
Browse Plan Formulary |
Healthfirst 65 Plus Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | n/a | None | $1.35 |
Browse Plan Formulary |
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $1.34 |
Browse Plan Formulary |
Humana Gold Plus H3533-027 (HMO)
|
$0.00 |
$400* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$6.00 | $0.00 | None | $2.57 |
Browse Plan Formulary |
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $2.37 |
Browse Plan Formulary |
RiverSpring FIDA Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $20.65 |
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 |
VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $3.74 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
|
$17.00 |
$350* | to be determined | 1* |
Preferred Generic |
$3.00 | $0.00 | Q:120 /30Days | $4.48 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$25.30 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | Q:120 /30Days | $4.48 |
Browse Plan Formulary |
Advantage Value One NY - Dual (HMO SNP)
|
$25.80 |
$405 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | n/a | None | $2.60 |
Browse Plan Formulary |
Humana Gold Plus H3533-010 (HMO)
|
$27.20 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | $0.00 | None | $2.57 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
|
$28.20 |
$225* | to be determined | 1* |
Preferred Generic |
$3.00 | $0.00 | Q:120 /30Days | $4.48 |
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 |
Healthfirst Increased Benefits Plan (HMO)
|
$29.70 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1.35 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$33.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | Q:120 /30Days | $4.39 |
Browse Plan Formulary |
WellCare Choice (HMO)
|
$35.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $1.47 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
|
$35.70 |
$100* | to be determined | 1* |
Preferred Generic |
$3.00 | $0.00 | Q:120 /30Days | $4.48 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$36.90 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.47 |
Browse Plan Formulary |
Spartan Plan NY I-SNP (HMO SNP)
|
$37.10 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
25% | n/a | None | $21.33 |
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 |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$38.00 |
$125* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | None | $1.59 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
|
$38.40 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | None | $1.59 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO SNP)
|
$39.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | None | $1.34 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO SNP)
|
$39.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | None | $1.34 |
Browse Plan Formulary |
AgeWell New York BeWell (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $4.05 |
Browse Plan Formulary |
AgeWell New York CareWell (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $4.05 |
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 |
AgeWell New York FeelWell (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | None | $4.05 |
Browse Plan Formulary |
AgeWell New York StayWell (HMO)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $4.05 |
Browse Plan Formulary |
CenterLight Healthcare Direct Complete Plan (HMO SNP)
|
$39.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Generic |
$10.25 | n/a | None | $21.20 |
Browse Plan Formulary |
Elderplan Advantage For Nursing Home Residents (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $2.19 |
Browse Plan Formulary |
Elderplan For Medicaid Beneficiaries (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $2.19 |
Browse Plan Formulary |
Elderplan Plus Long Term Care (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $2.19 |
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 |
EmblemHealth VIP Dual (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | Q:60 /30Days | $6.18 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage (HMO SNP)
|
$39.00 |
$405* | Yes, but No Gap Coverage for this drug. | 6* |
Select Care Drugs |
$0.00 | n/a | None | $6.51 |
Browse Plan Formulary |
Healthfirst AssuredCare (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1.35 |
Browse Plan Formulary |
Healthfirst CompleteCare (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | None | $1.35 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $1.35 |
Browse Plan Formulary |
RiverSpring MAP (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $20.65 |
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 |
RiverSpring Star (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $20.65 |
Browse Plan Formulary |
Senior Whole Health of New York NHC (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $7.01 |
Browse Plan Formulary |
Spartan Plan NY (HMO)
|
$39.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
25% | n/a | None | $21.33 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $3.76 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | n/a | None | $3.76 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$39.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | None | $3.77 |
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 |
EmblemHealth VIP Essential (HMO)
|
$46.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.64 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
|
$46.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.31 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
|
$46.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.81 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
|
$46.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.08 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$46.00 |
$350* | Yes, but No Gap Coverage for this drug. | 6* |
Select Care Drugs |
$0.00 | n/a | None | $5.38 |
Browse Plan Formulary |
Spartan Plan NY C-SNP (HMO SNP)
|
$49.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
25% | n/a | None | $21.33 |
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 |
Empire MediBlue Choice (HMO-POS)
|
$66.00 |
$350* | Yes, but No Gap Coverage for this drug. | 6* |
Select Care Drugs |
$0.00 | n/a | None | $5.38 |
Browse Plan Formulary |
Humana Gold Plus H3533-023 (HMO)
|
$67.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.57 |
Browse Plan Formulary |
Advantage Premium - LI (HMO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | n/a | None | $2.66 |
Browse Plan Formulary |
Centers Plan for Medicaid Advantage Plus (HMO SNP)
|
$99.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | None | $4.61 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$105.00 |
$200* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.26 |
Browse Plan Formulary |
EmblemHealth VIP Gold (HMO)
|
$109.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.31 |
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 |
EmblemHealth VIP Gold (HMO)
|
$109.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.64 |
Browse Plan Formulary |
EmblemHealth VIP Gold (HMO)
|
$109.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.81 |
Browse Plan Formulary |
EmblemHealth VIP Gold (HMO)
|
$109.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.08 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$119.60 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | n/a | None | $3.77 |
Browse Plan Formulary |
EmblemHealth VIP Gold Plus (HMO)
|
$297.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | n/a | Q:60 /30Days | $6.28 |
Browse Plan Formulary |