LISINOPRIL-HCTZ 10-12.5 MG TAB (500.000 EA ) (NDC: 68180051802)
2019 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 |
$395* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days | $3.74 |
Browse Plan Formulary |
Aetna Medicare Freedom Plan (PPO)
|
$0.00 |
$195* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$2.00 | $0.00 | None | $6.61 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$195* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$2.00 | $0.00 | None | $6.61 |
Browse Plan Formulary |
Commonwealth Care Alliance (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | 0% | None | $7.79 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
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 | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Harvard Pilgrim Stride Basic Rx (HMO)
|
$0.00 |
$415* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.11 |
Browse Plan Formulary |
Medicare HMO Blue SaverRx (HMO)
|
$0.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $3.00 | None | $4.77 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | $5.00 | None | $4.77 |
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 |
Tufts Health Unify (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Generic Drugs |
0% | 0% | None | $1.44 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$400* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
AARP MedicareComplete Choice (Regional PPO)
|
$21.40 |
$295* | to be determined | 1* |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days | $3.64 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $2.00 |
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)
|
$22.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $2.00 |
Browse Plan Formulary |
UnitedHealthcare Senior Care Options (HMO SNP)
|
$23.10 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
$0.00 | $0.00 | Q:30 /30Days | $3.56 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $3.00 | None | $4.78 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $3.00 | None | $4.76 |
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 |
BMC HealthNet Plan Senior Care Options (HMO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
$0.00 | $0.00 | None | $6.12 |
Browse Plan Formulary |
NaviCare (HMO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
$0.00 | $0.00 | None | $1.49 |
Browse Plan Formulary |
Senior Care Options Program (HMO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
$0.00 | $0.00 | None | $7.80 |
Browse Plan Formulary |
Senior Whole Health (HMO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
15% | 15% | None | $6.17 |
Browse Plan Formulary |
Senior Whole Health NHC (HMO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
15% | 15% | None | $6.17 |
Browse Plan Formulary |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
$0.00 | $0.00 | None | $1.45 |
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 Nursing Home Plan 1 (PPO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
25% | 25% | Q:30 /30Days | $3.56 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$36.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
25% | 25% | Q:30 /30Days | $3.55 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$42.00 |
$295* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days | $3.74 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
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 |
Aetna Medicare Freedom Complete (PPO)
|
$57.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$2.00 | $0.00 | None | $6.61 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx (HMO)
|
$67.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.11 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx (HMO)
|
$67.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.11 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
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 | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$76.00 |
$95* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days | $3.74 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $3.00 | None | $4.76 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $3.00 | None | $4.78 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $1.00 | None | $4.76 |
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 | 1* |
Preferred Generic |
$1.00 | $1.00 | None | $4.78 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx Plus (HMO)
|
$163.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.11 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx Plus (HMO)
|
$163.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.11 |
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)
|
$173.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$1.00 | $2.00 | None | $2.00 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$188.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
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)
|
$188.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$188.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$4.00 | $8.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $1.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $1.45 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
|
$262.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $1.00 | None | $4.77 |
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 |
Medicare HMO Blue PlusRx (HMO)
|
$292.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$1.00 | $1.00 | None | $4.77 |
Browse Plan Formulary |