GLIPIZIDE ER 10 MG TABLET ER 24 [Glucotrol XL] (NDC: 64980028101)
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 |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$2.00 | $0.00 | None | $9.59 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | None | $17.55 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | None | $17.12 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | None | $17.46 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | None | $16.77 |
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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | None | $17.08 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$125* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | $0.00 | None | $9.56 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$125* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$125* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$125* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | $0.00 | None | $9.61 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$125* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | $0.00 | None | $9.53 |
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)
|
$8.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.14 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$8.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.53 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$8.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$8.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$8.00 |
$405* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $16.25 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$8.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $0.00 | None | $9.53 |
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 Value Plan (PPO)
|
$10.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $9.53 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | $0.00 | None | $9.53 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | $0.00 | None | $9.61 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$13.00 | $0.00 | None | $9.56 |
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 H8087-001 (PPO)
|
$20.00 |
$195* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$2.00 | $0.00 | None | $7.40 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
|
$20.50 |
$150* | to be determined | 1* |
Preferred Generic |
$7.00 | $0.00 | None | $7.39 |
Browse Plan Formulary |
Humana Value Plus H8087-002 (PPO)
|
$23.90 |
$260* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $7.40 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$24.50 |
$415 | No additional gap coverage, only the Donut Hole Discount | 1 |
All Formulary Drugs |
$0.00 | $0.00 | Q:60 /30Days | $14.12 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$38.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$38.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.34 |
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)
|
$38.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $16.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$38.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.53 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$38.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 6* |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.14 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$42.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $0.00 | None | $9.61 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$42.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $0.00 | None | $9.53 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$42.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $0.00 | None | $9.56 |
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)
|
$42.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$42.00 |
$75* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$44.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $9.53 |
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 | $7.41 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$78.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$8.00 | $0.00 | None | $9.53 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $16.77 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.46 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.12 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.55 |
Browse Plan Formulary |
Humana Gold Choice H8145-006 (PFFS)
|
$94.00 |
$415* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$6.00 | $0.00 | None | $7.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$110.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.14 |
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)
|
$110.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$110.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$110.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $16.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$110.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.53 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$137.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $0.00 | None | $9.61 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$137.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $0.00 | None | $9.56 |
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)
|
$137.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$137.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $0.00 | None | $9.49 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$137.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$7.00 | $0.00 | None | $9.53 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$180.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $16.77 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$180.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$180.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.46 |
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 Prestige (HMO-POS)
|
$180.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.12 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$180.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $17.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$210.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$210.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $16.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$210.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$210.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.53 |
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)
|
$210.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$0.00 | $0.00 | Q:180 /90Days | $15.14 |
Browse Plan Formulary |