LEVORPHANOL 2 MG TABLET (NDC: 42358010210)
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 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | 28% | Q:180 /30Days | $4,486.45 |
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% | Q:240 /30Days | $5,035.05 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
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 |
2* |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
Medicare HMO Blue SaverRx (HMO)
|
$0.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$11.00 | $22.00 | None | $4,928.46 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$405* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$11.00 | $22.00 | None | $4,928.46 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
AARP MedicareComplete Choice (Regional PPO)
|
$21.40 |
$295 |
to be determined |
5 |
Specialty Tier |
27% | 27% | Q:180 /30Days | $4,486.46 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$9.00 | $18.00 | None | $5,492.84 |
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 |
2 |
Generic |
$9.00 | $18.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$9.00 | $18.00 | None | $5,492.84 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$9.00 | $18.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$9.00 | $18.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$22.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$9.00 | $18.00 | None | $4,807.20 |
Browse Plan Formulary |
UnitedHealthcare Senior Care Options (HMO SNP)
|
$23.10 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
5 |
All Formulary Drugs |
$0.00 | $0.00 | Q:180 /30Days | $4,486.45 |
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 |
Erickson Advantage Guardian (HMO-POS SNP)
|
$33.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | Q:180 /30Days | $4,486.45 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,926.33 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $5,117.64 |
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 | $4,806.81 |
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 | Q:240 /30Days | $5,035.05 |
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% | Q:120 /30Days | $4,852.51 |
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 |
Senior Whole Health NHC (HMO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
15% | 15% | Q:120 /30Days | $4,852.51 |
Browse Plan Formulary |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
5 |
All Formulary Drugs |
$0.00 | $0.00 | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
5 |
All Formulary Drugs |
25% | 25% | Q:180 /30Days | $4,486.45 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$42.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | 28% | Q:180 /30Days | $4,486.45 |
Browse Plan Formulary |
Erickson Advantage Freedom (HMO-POS)
|
$48.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | Q:180 /30Days | $4,486.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | Q:240 /30Days | $4,226.59 |
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 Basic Rx (HMO)
|
$55.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | Q:240 /30Days | $4,131.61 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx (HMO)
|
$67.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | Q:180 /30Days | $4,527.42 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx (HMO)
|
$67.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | Q:180 /30Days | $4,550.30 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $5,492.84 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
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 |
2* |
Generic |
$7.00 | $14.00 | None | $5,492.84 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$72.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$76.00 |
$95 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
31% | 31% | Q:180 /30Days | $4,486.45 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $5,117.64 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $4,926.33 |
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 |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | None | $5,117.64 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | None | $4,926.33 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | Q:240 /30Days | $4,131.61 |
Browse Plan Formulary |
Harvard Pilgrim Stride Value Rx Plus (HMO)
|
$163.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:180 /30Days | $4,527.42 |
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 |
Harvard Pilgrim Stride Value Rx Plus (HMO)
|
$163.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:180 /30Days | $4,550.30 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $5,492.84 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $4,807.20 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO)
|
$173.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $5,492.84 |
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 |
5 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$188.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $4,131.61 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$188.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$195.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | Q:180 /30Days | $4,486.45 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$195.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | Q:180 /30Days | $4,486.45 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $4,131.61 |
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 |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $4,226.59 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
|
$262.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | None | $4,928.46 |
Browse Plan Formulary |
Medicare HMO Blue PlusRx (HMO)
|
$292.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | None | $4,928.46 |
Browse Plan Formulary |