Minocycline Hydrochloride 75mg/1 100 FILM COATED TABLETS in BOTTLE (100 TABLET, FILM COATED i ) (NDC: 55111063801)
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 |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $158.10 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | Few Generics | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $164.85 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$4.00 | $0.00 | None | $159.70 |
Browse Plan Formulary |
BlueMedicare HMO LifeTime (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $137.50 |
Browse Plan Formulary |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$5.00 | $15.00 | None | $137.50 |
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 |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$30 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$33.00 | $99.00 | None | $137.50 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $228.81 |
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 |
Day Break (HMO)
|
$0.00 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $228.81 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $113.78 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $127.92 |
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 | None | $127.92 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$0.00 | n/a | None | $288.97 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
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 H1036-224 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$150* | Few Generics, Few Brands | 2* |
Non-Preferred Generic |
$15.00 | $0.00 | None | $402.86 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$89.00 | n/a | None | $164.85 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $108.45 |
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 Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $108.45 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | n/a | None | $157.74 |
Browse Plan Formulary |
Preferred Choice Broward (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$40.00 | $110.00 | None | $164.85 |
Browse Plan Formulary |
Simply Clear (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
25% | n/a | None | $91.80 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$0.00 | n/a | None | $288.97 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$0.00 | n/a | None | $288.97 |
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 |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $228.81 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-185 (HMO SNP)
|
$7.70 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$8.00 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
|
$10.50 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$11.70 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$17.00 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $433.74 |
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 SNP)
|
$19.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $158.56 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)
|
$20.60 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
25% | n/a | None | $165.56 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$21.20 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
25% | 25% | None | $165.56 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$21.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $158.10 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $115.37 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $115.37 |
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 |
MediMax (HMO)
|
$22.10 |
$310 | Call plan for details | 2 |
Non-Preferred Generic |
25% | n/a | None | $288.76 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $113.51 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $113.51 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$33.90 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $228.81 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$36.60 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$8.00 | $0.00 | None | $402.86 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$45.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $404.38 |
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 Choice H8145-061 (PFFS)
|
$103.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$15.00 | $0.00 | None | $403.05 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$127.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$5.00 | $15.00 | None | $137.50 |
Browse Plan Formulary |