NARATRIPTAN 2.5MG TABLETS (9 TABS X 1 BLPK ) (NDC: 00574021509)
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 |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$18.00 | $36.00 | Q:9 /30Days | $34.65 |
Browse Plan Formulary |
Humana Gold Plus H3533-006 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:9 /30Days | $25.67 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$8.00 | $16.00 | None | $31.22 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | Q:9 /30Days | $36.67 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | Q:9 /31Days | $66.93 |
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 HMO-SNP-DE H3533-008 (HMO SNP)
|
$13.80 |
$110 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:9 /30Days | $25.67 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$2.00 | $4.00 | Q:9 /31Days | $66.80 |
Browse Plan Formulary |
BasiCare with Part D (PPO)
|
$27.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:9 /30Days | $32.91 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$31.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | Q:9 /30Days | $36.67 |
Browse Plan Formulary |
CDPHP Value Rx (HMO)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:9 /30Days | $43.63 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$32.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$2.00 | $4.00 | Q:9 /31Days | $66.73 |
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 (HMO SNP)
|
$35.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $30.41 |
Browse Plan Formulary |
Today''s Options Advantage Plus 850B (PPO)
|
$36.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $45.00 | Q:9 /30Days | $41.01 |
Browse Plan Formulary |
Today''s Options Premier Plus 850B (PFFS)
|
$37.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $45.00 | Q:9 /30Days | $41.01 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO SNP)
|
$37.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:9 /30Days | $34.65 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
|
$37.20 |
$310 | Some Generics | 2 |
Non-Preferred Generic |
$23.00 | $46.00 | Q:9 /30Days | $34.65 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO SNP)
|
$37.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$29.00 | $58.00 | Q:9 /30Days | $34.65 |
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 |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$37.20 |
$240* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$15.00 | $30.00 | Q:9 /30Days | $34.65 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
|
$37.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:9 /30Days | $36.67 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$37.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | Q:9 /30Days | $36.67 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$37.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | Q:9 /30Days | $36.67 |
Browse Plan Formulary |
BlueShield Senior Blue 650 Part D (HMO-POS)
|
$39.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $30.00 | Q:54 /84Days | $31.76 |
Browse Plan Formulary |
Fidelis Long Term Care Advantage (HMO SNP)
|
$44.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:9 /30Days | $34.65 |
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 H5970-008 (PPO)
|
$48.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:9 /30Days | $25.67 |
Browse Plan Formulary |
Empire MediBlue Freedom I (PPO)
|
$50.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $120.00 | Q:9 /30Days | $56.97 |
Browse Plan Formulary |
GoldValue with Part D (HMO-POS)
|
$59.50 |
$0 | Few Generics | 1 |
Preferred Generic |
$10.00 | $20.00 | Q:9 /30Days | $32.99 |
Browse Plan Formulary |
GoldAnywhere with Part D - Option 2 (PPO)
|
$64.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$10.00 | $20.00 | Q:9 /30Days | $32.91 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
|
$67.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $120.00 | Q:9 /30Days | $56.20 |
Browse Plan Formulary |
Empire MediBlue Freedom II (PPO)
|
$72.00 |
$90 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $120.00 | Q:9 /30Days | $56.20 |
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 |
CDPHP Choice Rx (HMO)
|
$81.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $80.00 | Q:9 /30Days | $43.63 |
Browse Plan Formulary |
Today''s Options Advantage Plus 350A (PPO)
|
$90.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $40.00 | Q:9 /30Days | $41.01 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$92.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $40.00 | Q:9 /30Days | $41.01 |
Browse Plan Formulary |
BlueShield Senior Blue HMO 652 PartD (HMO)
|
$99.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $30.00 | Q:54 /84Days | $31.76 |
Browse Plan Formulary |
Preferred Gold with Part D (HMO-POS)
|
$117.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$10.00 | $20.00 | Q:9 /30Days | $32.99 |
Browse Plan Formulary |
CDPHP Core Rx (PPO)
|
$126.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:9 /30Days | $43.63 |
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 H5970-010 (PPO)
|
$133.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:9 /30Days | $25.67 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 750 (PPO)
|
$144.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $30.00 | Q:54 /84Days | $31.76 |
Browse Plan Formulary |
CDPHP Classic Rx (PPO)
|
$182.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $80.00 | Q:9 /30Days | $43.63 |
Browse Plan Formulary |
GoldAnywhere with Part D - Option 1 (PPO)
|
$238.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$8.00 | $16.00 | Q:9 /30Days | $32.91 |
Browse Plan Formulary |
CDPHP Prime Rx (PPO)
|
$256.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $80.00 | Q:9 /30Days | $43.63 |
Browse Plan Formulary |