LEVOCARNITINE 200MG/ML VIAL (5 X 5 ML PKG) (NDC: 00703040402)
2013 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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 Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | P | $52.96 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$0.00 | $0.00 | P | $53.78 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$0.00 | $0.00 | P | $53.78 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$33.00 | $66.00 | P | $57.39 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$4.00 | $8.00 | P | $48.77 |
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 |
CareFree PLUS (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | P | $56.02 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | P | $56.02 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | P | $56.02 |
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 |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | P | $56.02 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | P | $56.02 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | n/a | P | $52.96 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
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-DB H1036-188 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | P | $75.89 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 | All Generics | 1 |
Generic |
$0.00 | n/a | P | $54.79 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Generic |
$0.00 | n/a | P | $57.61 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Chronic Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Generic |
$0.00 | n/a | P | $57.61 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$0.00 | n/a | P | $57.61 |
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 |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | P | $51.82 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | P | $51.82 |
Browse Plan Formulary |
Preferred Medical Plan Choice (HMO)
|
$0.00 |
$0 | Many Generics, Some Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $52.56 |
Browse Plan Formulary |
Preferred Medical Plan Value (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | P | $52.56 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$90.00 | $270.00 | P | $54.05 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | n/a | P | $52.96 |
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 |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | n/a | P | $52.96 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 | to be determined | 3 |
Tier 3 |
$0.00 | $0.00 | P | $52.96 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$17.90 |
$325* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325* | to be determined | 1* |
Tier 1 |
$0.00 | $0.00 | P | $54.48 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$20.30 |
$325* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-187 (HMO SNP)
|
$21.30 |
$325* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | P | $75.89 |
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 H1036-163 (HMO SNP)
|
$21.90 |
$325* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$23.10 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | P | $56.02 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO SNP)
|
$23.40 |
$325* | to be determined | 1* |
Tier 1 |
$0.00 | n/a | P | $57.61 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $95.00 | None | $51.24 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 | Some Generics | 2 |
Non-Preferred Generic |
25% | 25% | P | $48.77 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | P | $56.02 |
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 |
MediMax (HMO)
|
$24.70 |
$325* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
25% | n/a | P | $52.96 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$24.80 |
$325* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $75.89 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | P | $56.02 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | P | $56.02 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | P | $52.96 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $110.00 | P | $75.89 |
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 Premier Plan (PPO)
|
$33.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$33.00 | $66.00 | P | $57.39 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 | Few Generics, Few Brands | 2 |
Preferred Brand |
$43.00 | $119.00 | P | $75.89 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | P | $75.89 |
Browse Plan Formulary |