ALINIA 100 MG/5 ML SUSPENSION (60 ML ) (NDC: 67546021221)
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% | None | $558.36 |
Browse Plan Formulary |
Aetna Medicare Freedom Plan (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
29% | n/a | None | $551.45 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
29% | n/a | None | $551.45 |
Browse Plan Formulary |
Commonwealth Care Alliance (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Preferred Brand Drugs |
0% | 0% | P Q:150 /3Days | $524.80 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
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 |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Flex Enhanced Rx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $538.33 |
Browse Plan Formulary |
Medicare HMO Blue SaverRx (HMO)
|
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $514.91 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $514.91 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $520.69 |
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 |
Fallon Senior Plan Super Saver Rx (HMO)
|
$16.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$16.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $538.33 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$16.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$16.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$16.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Super Saver Rx (HMO)
|
$16.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $566.24 |
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 |
5 |
Specialty Tier |
27% | 27% | None | $558.36 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$23.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $561.81 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$23.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $520.69 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$23.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $561.81 |
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 | None | $558.36 |
Browse Plan Formulary |
Health New England Medicare Value (HMO)
|
$25.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:180 /3Days | $547.33 |
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 ValueRx (HMO)
|
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $514.91 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
|
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $525.57 |
Browse Plan Formulary |
BMC HealthNet Plan Senior Care Options (HMO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
$0.00 | $0.00 | None | $536.27 |
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 | $528.24 |
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 | P Q:150 /3Days | $524.80 |
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 | $514.91 |
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% | None | $514.91 |
Browse Plan Formulary |
Tufts Health Plan Senior Care Options (HMO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
All Formulary Drugs |
$0.00 | $0.00 | None | $520.69 |
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% | None | $558.36 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$36.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
5 |
All Formulary Drugs |
25% | 25% | None | $558.36 |
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% | None | $558.36 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$50.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
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 |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$50.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$50.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$50.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $538.33 |
Browse Plan Formulary |
Fallon Senior Plan Saver Enhanced Rx (HMO)
|
$50.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$54.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $520.69 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$54.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $561.81 |
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)
|
$54.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $561.81 |
Browse Plan Formulary |
Aetna Medicare Freedom Complete (PPO)
|
$57.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $551.45 |
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% | None | $558.36 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $525.57 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
|
$76.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $514.91 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $561.81 |
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)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $561.81 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $520.69 |
Browse Plan Formulary |
Health New England Medicare Select (HMO-POS)
|
$90.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:180 /3Days | $547.33 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $525.57 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
|
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $514.91 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$99.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$80.00 | $240.00 | None | $561.81 |
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)
|
$99.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$80.00 | $240.00 | None | $520.69 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$99.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$80.00 | $240.00 | None | $561.81 |
Browse Plan Formulary |
Health New England Medicare Plus (HMO)
|
$109.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:180 /3Days | $547.33 |
Browse Plan Formulary |
Fallon Senior Plan Plus Enhanced Rx (HMO-POS)
|
$126.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$86.00 | $172.00 | None | $566.24 |
Browse Plan Formulary |
Health New England Medicare Premium (HMO)
|
$166.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:180 /3Days | $547.33 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
|
$262.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $514.91 |
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 |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $514.91 |
Browse Plan Formulary |