ERGOMAR 2 MG TABLET SL (NDC: 10802120200)
2014 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 |
Brand New Day Dementia with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:40 /28Days | $16.23 |
Browse Plan Formulary |
Brand New Day Diabetes with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:40 /28Days | $16.23 |
Browse Plan Formulary |
Brand New Day Enhanced Drug Savings for So Cal (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:40 /28Days | $16.24 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $15.50 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$30.00 | $60.00 | None | $15.42 |
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 |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.58 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$310* | Many Generics | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $15.58 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.58 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.58 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.58 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $15.58 |
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 |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.58 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.21 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$30.00 | $60.00 | None | $16.38 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:40 /28Days | $15.42 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Preferred Brand |
$40.00 | $80.00 | None | $16.59 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $17.14 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $16.29 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $16.29 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $17.14 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $16.31 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $16.29 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $17.14 |
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 |
Heart First (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $80.00 | None | $16.42 |
Browse Plan Formulary |
Humana Gold Plus H0108-011 (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $16.30 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$39.00 | $78.00 | None | $15.21 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $21.76 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $80.00 | None | $16.42 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $80.00 | None | $16.39 |
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 |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$39.00 | $78.00 | None | $16.42 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$4.00 |
$0 | to be determined | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $21.76 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$14.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $21.76 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$20.70 |
$310 | Few Generics | 3 |
Preferred Brand |
25% | 25% | None | $15.50 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$24.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | None | $16.39 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$24.40 |
$310 | Call plan for details | 3 |
Preferred Brand |
25% | 17% | Q:40 /28Days | $15.50 |
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 |
Coordinated Choice Plan (HMO)
|
$26.30 |
$310 | Few Generics | 3 |
Preferred Brand |
25% | 25% | None | $15.42 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$28.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $16.39 |
Browse Plan Formulary |
Brand New Day Dementia with Extra Care (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:40 /28Days | $16.23 |
Browse Plan Formulary |
Brand New Day Diabetes with Extra Care (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:40 /28Days | $16.23 |
Browse Plan Formulary |
Brand New Day Dual Coverage (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | Q:40 /28Days | $16.23 |
Browse Plan Formulary |
Brand New Day Extra Care (HMO)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:40 /28Days | $16.23 |
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 |
Brand New Day for Mental Illness (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:40 /28Days | $16.23 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $16.31 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$13.00 | $26.00 | None | $16.31 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | Q:40 /28Days | $16.51 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | None | $16.39 |
Browse Plan Formulary |
VillageHealth (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $16.42 |
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 |
Inter Valley Health Plan Total Fit (HMO)
|
$30.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | None | $15.21 |
Browse Plan Formulary |