AMLODIPINE-BENAZEPRIL 10-20 MG Capsule [Lotrel] (30 capsules BOT) (NDC: 00093737301)
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 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days | $11.02 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$195* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days | $11.01 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (PPO)
|
$0.00 |
$345* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $9.59 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$295* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $9.26 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$195* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.37 |
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 |
Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | None | $44.25 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $36.00 | None | $48.32 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $36.00 | None | $48.71 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $36.00 | None | $47.53 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $36.00 | None | $44.20 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $36.00 | None | $52.48 |
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 |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $36.00 | None | $41.62 |
Browse Plan Formulary |
Amerivantage COPD (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$0.00 | $0.00 | None | $43.13 |
Browse Plan Formulary |
Amerivantage Diabetes (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$0.00 | $0.00 | None | $43.13 |
Browse Plan Formulary |
Amerivantage Heart (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$0.00 | $0.00 | None | $43.13 |
Browse Plan Formulary |
Amerivantage Select (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $43.86 |
Browse Plan Formulary |
Blue Cross Medicare Advantage Basic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $24.00 | None | $10.24 |
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 |
Cigna-HealthSpring Preferred (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $11.18 |
Browse Plan Formulary |
Humana Gold Plus H0028-038 (HMO)
|
$0.00 |
$360* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | Q:60 /30Days | $7.05 |
Browse Plan Formulary |
Humana Gold Plus H0028-042 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days | $7.04 |
Browse Plan Formulary |
Imperial Insurance Company of Texas Traditional (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $10.00 | Q:30 /30Days | $16.85 |
Browse Plan Formulary |
Imperial Insurance Company of Texas Value HMO SNP (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$3.00 | $0.00 | Q:30 /30Days | $16.85 |
Browse Plan Formulary |
KelseyCare Advantage Rx (HMO)
|
$0.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | None | $14.61 |
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 |
Memorial Hermann Advantage (HMO)
|
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $30.00 | None | $23.10 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | None | $6.49 |
Browse Plan Formulary |
UnitedHealthcare Connected (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | Q:30 /30Days | $11.05 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice (Regional PPO SNP)
|
$0.00 |
$415 |
to be determined |
1 |
All Formulary Drugs |
$0.00 | $0.00 | Q:30 /30Days | $11.28 |
Browse Plan Formulary |
UnitedHealthcare Medicare Silver (Regional PPO SNP)
|
$0.00 |
$364 |
to be determined |
1 |
Preferred Generic |
25% | 25% | Q:30 /30Days | $11.28 |
Browse Plan Formulary |
WellCare Dividend Prime (HMO)
|
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $20.54 |
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 |
WellCare TexanPlus Choice (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $20.60 |
Browse Plan Formulary |
WellCare TexanPlus Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $20.60 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $20.56 |
Browse Plan Formulary |
UnitedHealthcare Medicare Gold (Regional PPO SNP)
|
$6.50 |
$295* |
to be determined |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $11.28 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$15.00 |
$245* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.23 |
Browse Plan Formulary |
HumanaChoice H5216-043 (PPO)
|
$15.00 |
$295* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | Q:60 /30Days | $7.29 |
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 |
HumanaChoice H5216-043 (PPO)
|
$15.00 |
$295* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | Q:60 /30Days | $7.21 |
Browse Plan Formulary |
Cigna-HealthSpring TotalCare (HMO SNP)
|
$17.70 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
15% | 15% | Q:30 /30Days | $11.18 |
Browse Plan Formulary |
Blue Cross Medicare Advantage Choice Plus (PPO)
|
$20.00 |
$415* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$14.00 | $42.00 | None | $10.23 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$23.40 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
15% | 15% | Q:30 /30Days | $11.15 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H0028-031 (HMO SNP)
|
$23.90 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $7.18 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H0028-033 (HMO SNP)
|
$23.90 |
$365* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $7.05 |
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 R4182-004 (Regional PPO)
|
$23.90 |
$175* |
to be determined |
1* |
Preferred Generic |
$6.00 | $0.00 | Q:60 /30Days | $7.22 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $60.00 | None | $41.62 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $60.00 | None | $48.32 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $60.00 | None | $48.71 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $60.00 | None | $47.53 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $60.00 | None | $44.20 |
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 |
Amerivantage Dual Coordination (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $60.00 | None | $52.48 |
Browse Plan Formulary |
Amerivantage Dual Premier (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $60.00 | None | $44.20 |
Browse Plan Formulary |
Imperial Insurance Company of Texas Dual (HMO SNP) (HMO SNP)
|
$24.00 |
$415 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | 25% | Q:30 /30Days | $16.85 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$24.00 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $6.51 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$24.00 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
25% | 25% | Q:30 /30Days | $10.75 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$24.00 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $20.56 |
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 |
WellCare Liberty (HMO SNP)
|
$24.00 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $20.56 |
Browse Plan Formulary |
WellCare TexanPlus Star (HMO SNP)
|
$24.00 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $20.56 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice (Regional PPO)
|
$28.50 |
$325* |
to be determined |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $11.28 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS SNP)
|
$33.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.79 |
Browse Plan Formulary |
HumanaChoice R4182-003 (Regional PPO)
|
$33.70 |
$175* |
to be determined |
1* |
Preferred Generic |
$7.00 | $0.00 | Q:60 /30Days | $7.22 |
Browse Plan Formulary |
Erickson Advantage Freedom (HMO-POS)
|
$48.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days | $10.79 |
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 |
KelseyCare Advantage Rx+Choice (HMO-POS)
|
$77.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | None | $14.61 |
Browse Plan Formulary |
HumanaChoice H5216-042 (PPO)
|
$87.00 |
$175* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | Q:60 /30Days | $7.22 |
Browse Plan Formulary |
Blue Cross Medicare Advantage Choice Premier (PPO)
|
$90.00 |
$415* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$14.00 | $42.00 | None | $10.23 |
Browse Plan Formulary |
Humana Gold Choice H8145-084 (PFFS)
|
$116.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$6.00 | $0.00 | Q:60 /30Days | $7.17 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$150.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.23 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$195.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.79 |
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 |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$195.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days | $10.79 |
Browse Plan Formulary |