ECONAZOLE NITRATE 1% CREAM (G) [Spectazole] (30 GRAMS ) (NDC: 45802046653)
2022 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 Medicare Advantage Choice (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $57.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice Plan 2 (Regional PPO)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $57.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Choice (HMO-POS)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:85 /30Days | $95.20 |
Browse Plan Formulary |
Aetna Medicare Credit (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:85 /30Days | $95.20 |
Browse Plan Formulary |
Aetna Medicare Premier (PPO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:85 /30Days | $95.20 |
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 |
Aetna Medicare Select (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$35.00 | $105.00 | Q:85 /30Days | $95.20 |
Browse Plan Formulary select insulin pay $20 copay but not this drug |
Align Connect (HMO C-SNP)
|
$0.00 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | Q:85 /30Days | $47.60 |
Browse Plan Formulary |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $73.95 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $73.95 |
Browse Plan Formulary select insulin pay $12 copay but not this drug |
Bright Advantage Classic Care Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
Bright Advantage Embrace Care Plan (HMO C-SNP)
|
$0.00 |
$0 |
Some Generics |
4 |
Non-Preferred Drug |
$90.00 | $180.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary select insulin pay $0-$35 copay but not this drug |
|
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 |
Bright Advantage Part B Savings Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
Bright New Day (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$5.00 | $10.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
CareBreeze (HMO C-SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Drug |
$35.00 | $95.00 | P Q:85 /30Days | $22.95 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
CareComplete (HMO C-SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Drug |
$35.00 | $95.00 | P Q:85 /30Days | $22.95 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | P Q:85 /30Days | $22.95 |
Browse Plan Formulary select insulin pay $10-$35 copay but not this drug |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$25.00 | $65.00 | P Q:85 /30Days | $22.95 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
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 |
DrExtraCare (HMO-POS C-SNP)
|
$0.00 |
$0 |
Many Generics, Some Brands |
4 |
Non-Preferred Drug |
$40.00 | $120.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary select insulin pay $10 copay but not this drug |
DrMax (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$45.00 | $135.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
DrValue (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
HealthSun HealthAdvantage Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $81.60 |
Browse Plan Formulary |
HealthSun HealthAdvantage Plus (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $81.60 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary select insulin pay $10-$35 copay but not this drug |
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 H1036-054C (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$5.00 | $5.00 | P Q:85 /30Days | $22.95 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Humana Gold Plus H1036-237 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$80.00 | $230.00 | P Q:85 /30Days | $22.95 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Humana Gold Plus H1036-237 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$80.00 | $230.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
HumanaChoice Florida H5216-068 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary |
HumanaChoice Florida H7284-008 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary |
Leon Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | n/a | Q:85 /28Days | $85.00 |
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 |
Leon MediExtra (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | n/a | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
Leon MediMore (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | n/a | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
MedicareMax (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$65.00 | $185.00 | Q:90 /30Days | $57.80 |
Browse Plan Formulary select insulin pay $20 copay but not this drug |
PHP (HMO C-SNP)
|
$0.00 |
$480 |
Few Generics |
1 |
Generic |
15% | n/a | Q:170 /30Days | $29.75 |
Browse Plan Formulary |
Preferred Choice Dade (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$40.00 | $110.00 | Q:90 /30Days | $57.80 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Preferred Special Care Miami-Dade (HMO C-SNP)
|
$0.00 |
$0 |
Some Generics, Some Brands |
4 |
Non-Preferred Drug |
$45.00 | $125.00 | Q:90 /30Days | $57.80 |
Browse Plan Formulary select insulin pay $15 copay but not this drug |
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 |
Simply Care (HMO I-SNP)
|
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | n/a | Q:90 /30Days | $85.00 |
Browse Plan Formulary |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$480* |
Some Generics, Few Brands |
1* |
Preferred Generic |
$0.00 | n/a | Q:90 /30Days | $85.00 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $82.45 |
Browse Plan Formulary |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 |
Many Generics, Some Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $82.45 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $82.45 |
Browse Plan Formulary |
SOLIS SPF 001 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:85 /30Days | $42.50 |
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 R5826-074 (Regional PPO)
|
$0.50 |
$395 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:85 /30Days | $27.20 |
Browse Plan Formulary |
HumanaChoice Florida H7284-007 (PPO)
|
$11.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary |
CareNeeds PLUS (HMO D-SNP)
|
$13.20 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary |
CareExtra (HMO)
|
$19.20 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
24% | 24% | P Q:85 /30Days | $22.95 |
Browse Plan Formulary select insulin pay $0-$35 copay but not this drug |
Humana Fully Integrated H1036-280 (HMO D-SNP)
|
$19.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)
|
$21.80 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | P Q:85 /30Days | $22.95 |
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 |
Align Thrive (HMO I-SNP)
|
$22.90 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | Q:85 /30Days | $47.60 |
Browse Plan Formulary |
DrPlus (HMO-POS D-SNP)
|
$26.40 |
$0 |
Many Generics, Some Brands |
4 |
Non-Preferred Drug |
$35.00 | $105.00 | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
Aetna Medicare Assure Plus (HMO D-SNP)
|
$27.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
40% | 40% | Q:85 /30Days | $95.20 |
Browse Plan Formulary |
DrFirst (HMO-POS)
|
$29.50 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
25% | 25% | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
MedicareMax Plus 2 (HMO D-SNP)
|
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:90 /30Days | $57.80 |
Browse Plan Formulary |
Preferred Medicare Assist Plan 2 (HMO D-SNP)
|
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:90 /30Days | $57.80 |
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 |
UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
|
$31.50 |
$480 |
No |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $57.80 |
Browse Plan Formulary |
DrChoice (HMO-POS)
|
$33.40 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
25% | 25% | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
Preferred Medicare Assist Plan 1 (HMO D-SNP)
|
$34.00 |
$480 |
Some Generics, Few Brands |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $57.80 |
Browse Plan Formulary |
Aetna Medicare Assure (HMO D-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
40% | 40% | Q:85 /30Days | $95.20 |
Browse Plan Formulary |
BlueMedicare Complete (HMO D-SNP)
|
$34.30 |
$480* |
Some Generics, Few Brands |
2* |
Generic |
$0.00 | $0.00 | None | $73.95 |
Browse Plan Formulary |
Bright Advantage Embrace Assist Plan (HMO C-SNP)
|
$34.30 |
$480 |
Some Generics |
4 |
Non-Preferred Drug |
25% | 25% | Q:170 /30Days | $28.90 |
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 |
Bright Advantage Embrace Choice Plan (HMO C-SNP)
|
$34.30 |
$480 |
Some Generics |
4 |
Non-Preferred Drug |
25% | 25% | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
HealthSun MediMax (HMO)
|
$34.30 |
$430 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | 25% | Q:90 /30Days | $85.00 |
Browse Plan Formulary |
HealthSun MediSun Extra (HMO D-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | 25% | Q:90 /30Days | $85.00 |
Browse Plan Formulary |
HealthSun MediSun Plus (HMO D-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | 25% | Q:90 /30Days | $85.00 |
Browse Plan Formulary |
Leon MediDual (HMO D-SNP)
|
$34.30 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Generic |
$0.00 | n/a | Q:170 /30Days | $28.90 |
Browse Plan Formulary |
Longevity Health Plan (HMO I-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:85 /28Days | $79.05 |
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 |
MedicareMax Plus 1 (HMO D-SNP)
|
$34.30 |
$480 |
Some Generics, Few Brands |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $57.80 |
Browse Plan Formulary |
Simply Complete (HMO D-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$10.00 | $30.00 | Q:90 /30Days | $81.60 |
Browse Plan Formulary |
SOLIS SPF 002 (HMO D-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | Q:85 /30Days | $42.50 |
Browse Plan Formulary |
SOLIS SPF 011 (HMO C-SNP)
|
$34.30 |
$0 |
Many Generics, Some Brands |
1 |
Preferred Generic |
0% | 0% | Q:85 /30Days | $42.50 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $57.80 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $57.80 |
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 |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
|
$34.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $57.80 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
|
$36.60 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $56.10 |
Browse Plan Formulary |
BlueMedicare Choice (Regional PPO)
|
$47.90 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $30.00 | None | $82.45 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-065 (PPO)
|
$53.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | P Q:85 /30Days | $24.65 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$55.00 |
$100 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | P Q:85 /30Days | $27.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | P Q:85 /30Days | $27.20 |
Browse Plan Formulary |