SERTRALINE HCL 100 MG TABLET (500.000 EA ) (NDC: 65862001305)
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 6 (HMO)
|
$0.00 |
$225* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | None | $6.52 |
Browse Plan Formulary |
Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | None | $8.56 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $8.14 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$145* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $6.70 |
Browse Plan Formulary |
Allwell Medicare (HMO)
|
$0.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.86 |
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 Essential (HMO)
|
$0.00 |
$60* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:60 /30Days | $11.19 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:60 /30Days | $11.29 |
Browse Plan Formulary |
Bright Advantage (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $8.00 | None | $5.69 |
Browse Plan Formulary |
Bright Advantage Flex (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $8.00 | None | $5.69 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
|
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$6.00 | $0.00 | None | $4.31 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO SNP)
|
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | Q:60 /30Days | $2.85 |
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 H6622-021 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
Humana Gold Plus H6622-021 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
HumanaChoice H5525-042 (PPO)
|
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
MediGold Southwest OH Essential Care (HMO)
|
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $4.00 | None | $3.06 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.02 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.79 |
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 |
MeridianCare Enhanced (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $8.00 | None | $41.29 |
Browse Plan Formulary |
MeridianCare Essential (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $41.29 |
Browse Plan Formulary |
MeridianCare Essential Smile (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $41.29 |
Browse Plan Formulary |
Molina Dual Options ? MyCareOhio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | None | $4.17 |
Browse Plan Formulary |
Mutual of Omaha CareAdvantage Complete (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $9.43 |
Browse Plan Formulary |
Humana Gold Plus H6622-055 (HMO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.85 |
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 H5216-109 (PPO)
|
$19.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold 2 (Regional PPO)
|
$21.50 |
$350* |
to be determined |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $7.12 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$25.60 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
15% | 15% | None | $6.41 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
|
$26.40 |
$395* |
to be determined |
1* |
Preferred Generic |
$9.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$28.00 |
$170* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | None | $6.49 |
Browse Plan Formulary |
Mutual of Omaha CareAdvantage Plus (HMO)
|
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $9.72 |
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 |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO SNP)
|
$32.90 |
$50* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $4.53 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO SNP)
|
$32.90 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $11.29 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$32.90 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $11.29 |
Browse Plan Formulary |
CareSource Advantage (HMO)
|
$32.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $10.00 | None | $4.31 |
Browse Plan Formulary |
MeridianCare Extra (HMO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | None | $41.29 |
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 |
MeridianCare Extra Smile (HMO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | None | $41.29 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
25% | 25% | None | $6.33 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
25% | 25% | None | $6.50 |
Browse Plan Formulary |
Bright Advantage Plus (HMO)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.69 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.02 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.79 |
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. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.02 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.79 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold (Regional PPO)
|
$53.30 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $7.06 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$56.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:60 /30Days | $11.22 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$56.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:60 /30Days | $11.19 |
Browse Plan Formulary |
Bright Advantage Flex Plus (PPO)
|
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.69 |
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 H5216-023 (PPO)
|
$57.00 |
$175* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
MediGold Flexible Choice (PPO)
|
$57.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $4.00 | None | $3.06 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
|
$57.80 |
$200* |
to be determined |
1* |
Preferred Generic |
$6.00 | $0.00 | Q:60 /30Days | $11.29 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$63.00 |
$60* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:60 /30Days | $11.74 |
Browse Plan Formulary |
CareSource Advantage Plus (HMO)
|
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.31 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.02 |
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 Preferred (PPO)
|
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.79 |
Browse Plan Formulary |
Humana Gold Plus H6622-019 (HMO)
|
$87.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$98.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $7.25 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.02 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.79 |
Browse Plan Formulary |
Humana Gold Choice H8145-032 (PFFS)
|
$103.00 |
$225* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | Q:60 /30Days | $2.85 |
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. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.52 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.02 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $7.21 |
Browse Plan Formulary |
MediGold Southwest OH Classic Preferred (HMO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.06 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
|
$155.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $0.00 | Q:60 /30Days | $2.85 |
Browse Plan Formulary |