LEVOTHYROXINE 150 MCG TABLET (1000.000 EA ) (NDC: 00378181510)
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 | $16.27 |
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 | $15.80 |
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 | $16.19 |
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 | $16.17 |
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 | $16.33 |
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 |
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 | $16.20 |
Browse Plan Formulary |
MeridianCare Essential (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | n/a | None | $11.13 |
Browse Plan Formulary |
MeridianComplete (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | n/a | None | $11.23 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | n/a | None | $14.84 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | n/a | None | $15.02 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | n/a | None | $14.65 |
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 |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | n/a | None | $15.82 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | n/a | None | $15.76 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$9.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | n/a | None | $15.76 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | n/a | None | $14.84 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | n/a | None | $15.02 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | n/a | None | $14.65 |
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 |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | n/a | None | $15.76 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$18.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | n/a | None | $15.82 |
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 | $16.19 |
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 | $15.80 |
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 | $16.10 |
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 | $16.35 |
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 | $16.33 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
|
$20.00 |
$405 | to be determined | 1 |
Preferred Generic |
19% | 19% | None | $14.32 |
Browse Plan Formulary |
MeridianCare Extra (HMO SNP)
|
$33.30 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | n/a | None | $11.13 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | n/a | None | $15.82 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | n/a | None | $14.65 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | n/a | None | $15.02 |
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 |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | n/a | None | $14.84 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$37.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | n/a | None | $15.76 |
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 | $16.35 |
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 | $16.33 |
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 | $15.80 |
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 | $16.19 |
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 |
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 | $16.10 |
Browse Plan Formulary |
HumanaChoice H5216-009 (PPO)
|
$75.00 |
$105* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$6.00 | $0.00 | None | $14.32 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$90.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | n/a | None | $15.76 |
Browse Plan Formulary |
Humana Gold Choice H8145-006 (PFFS)
|
$97.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$6.00 | $0.00 | None | $14.55 |
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 | $16.20 |
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 | $16.33 |
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 |
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 | $16.17 |
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 | $15.80 |
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 | $16.19 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | n/a | None | $14.84 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | n/a | None | $15.02 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | n/a | None | $14.65 |
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 |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | n/a | None | $15.82 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$129.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | n/a | None | $15.76 |
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 | $16.33 |
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 | $15.80 |
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 | $16.10 |
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 | $16.19 |
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 |
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 | $16.35 |
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 | $16.20 |
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 | $16.33 |
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 | $16.17 |
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 | $16.19 |
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 | $15.80 |
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 |
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 | $15.80 |
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 | $16.10 |
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 | $16.19 |
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 | $16.35 |
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 | $16.33 |
Browse Plan Formulary |