ESTRADIOL TDS 0.1 MG/DAY (4 EA ) (NDC: 00378335299)
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 7 (HMO)
|
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:4 /28Days | $64.89 |
Browse Plan Formulary |
Advantra Silver (PPO)
|
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:4 /28Days | $47.69 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:4 /28Days | $47.62 |
Browse Plan Formulary |
Allwell Medicare (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$37.00 | $111.00 | P | $65.91 |
Browse Plan Formulary |
Anthem MediBlue Essential (HMO)
|
$0.00 |
$60 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $63.36 |
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 |
Anthem MediBlue Preferred (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $63.16 |
Browse Plan Formulary |
Bright Advantage (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $70.40 |
Browse Plan Formulary |
Bright Advantage Flex (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $70.40 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $41.08 |
Browse Plan Formulary |
CareSource MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | 0% | None | $41.39 |
Browse Plan Formulary |
Humana Gold Plus H6622-014 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $60.71 |
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 |
HumanaChoice H5525-042 (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $60.69 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | P Q:4 /28Days | $59.41 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | P Q:4 /28Days | $58.50 |
Browse Plan Formulary |
PrimeTime Health Plan Aultimate (HMO-POS)
|
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $45.00 | None | $59.23 |
Browse Plan Formulary |
SummaCare Medicare Topaz (HMO)
|
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $25.00 | P Q:4 /28Days | $60.40 |
Browse Plan Formulary |
The Health Plan SecureCare - Option IV (HMO)
|
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | P Q:4 /28Days | $58.68 |
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 Connected for MyCareOhio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | Q:4 /28Days | $64.89 |
Browse Plan Formulary |
HumanaChoice H5216-106 (PPO)
|
$15.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $60.83 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$18.00 |
$170* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:4 /28Days | $64.89 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold 2 (Regional PPO)
|
$21.50 |
$350 |
to be determined |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:4 /28Days | $47.44 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$25.60 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
All Formulary Drugs |
15% | 15% | Q:4 /28Days | $64.91 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
|
$26.40 |
$395 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $60.70 |
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 |
Humana Gold Plus SNP-DE H6622-015 (HMO SNP)
|
$31.20 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $60.53 |
Browse Plan Formulary |
Aetna Better Health of Ohio Dual Preferred (HMO SNP)
|
$32.10 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:4 /28Days | $47.60 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO-POS SNP)
|
$32.60 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
All Formulary Drugs |
25% | 25% | Q:4 /28Days | $64.87 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO SNP)
|
$32.90 |
$50 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | P | $60.11 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO SNP)
|
$32.90 |
$415 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:4 /28Days | $63.16 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$32.90 |
$415 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:4 /28Days | $63.16 |
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 |
CareSource Advantage (HMO)
|
$32.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $41.08 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
All Formulary Drugs |
25% | 25% | Q:4 /28Days | $64.99 |
Browse Plan Formulary |
Bright Advantage Plus (HMO)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $70.40 |
Browse Plan Formulary |
The Health Plan SecureCare SNP (HMO SNP)
|
$36.70 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
All Formulary Drugs |
15% | 15% | P Q:4 /28Days | $57.59 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $58.50 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $59.41 |
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 |
MedMutual Advantage Select (PPO)
|
$38.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | P Q:4 /28Days | $58.50 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | P Q:4 /28Days | $59.41 |
Browse Plan Formulary |
PrimeTime Health Plan Classic (HMO-POS)
|
$39.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $20.00 | None | $59.23 |
Browse Plan Formulary |
HumanaChoice H5216-051 (PPO)
|
$43.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $60.98 |
Browse Plan Formulary |
SummaCare Medicare Ruby (HMO)
|
$43.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $25.00 | P Q:4 /28Days | $60.40 |
Browse Plan Formulary |
The Health Plan SecureCare - Option II (HMO)
|
$46.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | P Q:4 /28Days | $58.68 |
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 |
Aetna Medicare OH Connect Gold (Regional PPO)
|
$53.30 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:4 /28Days | $47.52 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$56.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $62.59 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$56.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $63.80 |
Browse Plan Formulary |
Bright Advantage Flex Plus (PPO)
|
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $70.40 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
|
$57.80 |
$200 |
to be determined |
4 |
Non-Preferred Drug |
41% | 41% | P Q:4 /28Days | $63.16 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$63.00 |
$60 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $63.37 |
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 |
The Health Plan SecureChoice - Option II (PPO)
|
$66.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | P Q:4 /28Days | $58.68 |
Browse Plan Formulary |
CareSource Advantage Plus (HMO)
|
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $41.08 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $59.41 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $58.50 |
Browse Plan Formulary |
SummaCare Medicare Sapphire (HMO-POS)
|
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $25.00 | P Q:4 /28Days | $60.40 |
Browse Plan Formulary |
Anthem MediBlue Access Plus (PPO)
|
$87.00 |
$40 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $63.16 |
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 |
Humana Gold Plus H6622-019 (HMO)
|
$87.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | Q:4 /28Days | $60.55 |
Browse Plan Formulary |
PrimeTime Health Plan Plus (HMO-POS)
|
$89.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$6.00 | $15.00 | None | $59.23 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$98.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:4 /28Days | $47.44 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $59.41 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $58.50 |
Browse Plan Formulary |
Humana Gold Choice H8145-032 (PFFS)
|
$103.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $60.49 |
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)
|
$111.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:4 /28Days | $64.82 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $58.50 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | P Q:4 /28Days | $59.41 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:4 /28Days | $47.46 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
|
$155.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | Q:4 /28Days | $60.66 |
Browse Plan Formulary |
SummaCare Medicare Emerald (HMO-POS)
|
$180.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $20.00 | P Q:4 /28Days | $60.40 |
Browse Plan Formulary |