OLMESARTAN MEDOXOMIL 40 MG TAB [Benicar] (30.000 EA ) (NDC: 00378712493)
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 |
2* |
Generic |
$12.00 | $0.00 | Q:30 /30Days | $17.13 |
Browse Plan Formulary |
Aetna Medicare Freedom Plan (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:30 /30Days | $46.44 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:30 /30Days | $46.44 |
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 | $16.18 |
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 | $78.84 |
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 Flex Enhanced Rx (HMO)
|
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $78.84 |
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 | $78.84 |
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 | $78.84 |
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 | $15.63 |
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 | $15.63 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
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 Choice (Regional PPO)
|
$21.40 |
$295* |
to be determined |
2* |
Generic |
$12.00 | $0.00 | Q:30 /30Days | $17.98 |
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 | $78.84 |
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 | $78.84 |
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 | $78.84 |
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 | $78.84 |
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 | $78.84 |
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 | $78.84 |
Browse Plan Formulary |
UnitedHealthcare Senior Care Options (HMO SNP)
|
$23.10 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
All Formulary Drugs |
$0.00 | $0.00 | Q:30 /30Days | $17.38 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS SNP)
|
$33.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.31 |
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 | $15.17 |
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 | $15.71 |
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 | $66.77 |
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 |
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 | $16.18 |
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 | $52.23 |
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 | $52.23 |
Browse Plan Formulary |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
All Formulary Drugs |
$0.00 | $0.00 | None | $38.24 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
All Formulary Drugs |
25% | 25% | Q:30 /30Days | $17.38 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$42.00 |
$225* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $0.00 | Q:30 /30Days | $17.13 |
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 Freedom (HMO-POS)
|
$48.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $18.31 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$55.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
Browse Plan Formulary |
Aetna Medicare Freedom Complete (PPO)
|
$57.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:30 /30Days | $46.44 |
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 | None | $13.97 |
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 (HMO)
|
$67.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | None | $13.97 |
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 | $78.84 |
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 | $78.84 |
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 | $78.84 |
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 | $78.84 |
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 | $78.84 |
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 |
AARP MedicareComplete Plan 3 (HMO)
|
$76.00 |
$95* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $17.13 |
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 | $15.17 |
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 | $15.71 |
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 | $15.71 |
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 | $15.17 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
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 Value Rx (HMO)
|
$151.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$151.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
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 | None | $13.97 |
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 | None | $13.97 |
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 | $78.84 |
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 | $78.84 |
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 Plus Enhanced Rx (HMO)
|
$173.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $78.84 |
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 | $78.84 |
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 | $78.84 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$188.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$188.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$188.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $38.24 |
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 Champion (HMO-POS SNP)
|
$195.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $18.31 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$195.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $18.31 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $60.00 | None | $38.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $60.00 | None | $38.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $60.00 | None | $38.24 |
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 | $15.63 |
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 | $15.63 |
Browse Plan Formulary |