There are 38 stand-alone Medicare Part D plans in Wisconsin meeting your criteria.
Caution: The 2009 Medicare Part D plan information below is for research purposes.
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KETOROLAC INJECTION 60MG/2ML 25X1ML ON 2ML VIALSD (25X1ML ON 2ML VIALSD) (NDC: 10019003003) 2009 Medicare Prescription Drug Plan (PDP) Information Click here for the Chart Legend | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information | Cost-Sharing | Drug Usage Mgmt |
|||
---|---|---|---|---|---|---|---|---|---|
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Order |
||||||
First Health Part D-Secure |
$13.70 | $175 | No Gap Coverage | 1 | Preferred Generic | $4.00 | n/a | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Value |
$23.10 | $0 | No Gap Coverage | 1 | Preferred Generic | $8.00 | $16.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver |
$28.70 | $295 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $76.50 | $214.50 | Q:20 /31Days | |
Browse Plan Formulary | |||||||||
Community CCRx Basic |
$31.00 | $295 | No Gap Coverage | 1 | Generic | $0.00 | n/a | Q:20 /30Days | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier |
$31.10 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Prescriba Rx Bronze |
$31.30 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | Q:20 /30Days | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials |
$34.60 | $200 | No Gap Coverage | 2 | Tier 2 - Non-Preferred Generic | $12.00 | $24.00 | P Q:20 /5Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One |
$34.80 | $295 | No Gap Coverage | 1 | Tier 1 | $3.00 | $7.50 | P | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold |
$34.90 | $0 | No Gap Coverage | 1 | Generic | $6.00 | $12.00 | Q:20 /30Days | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$35.00 | $295 | No Gap Coverage | 4 | Injectable | 25% | n/a | None | |
Browse Plan Formulary | |||||||||
SilverScript Value |
$35.10 | $295 | No Gap Coverage | 1 | Generic | $8.00 | $12.00 | None | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Humana PDP Enhanced S5884-014 |
$35.70 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver |
$36.20 | $295 | No Gap Coverage | 1 | Tier 1 Preferred Generic | $4.00 | $12.00 | None | |
Browse Plan Formulary | |||||||||
HealthSpring Prescription Drug Plan-Reg 16 |
$36.30 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | Q:20 /30Days | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Value |
$36.60 | $130 | No Gap Coverage | 4 | Tier 4 Non-Specialty Injectable | 29% | 29% | None | |
Browse Plan Formulary | |||||||||
Community CCRx Choice |
$37.10 | $0 | No Gap Coverage | 1 | Generic | $5.00 | n/a | Q:20 /30Days | |
Browse Plan Formulary | |||||||||
WellCare Classic |
$37.80 | $295 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Sterling Rx |
$39.10 | $295 | No Gap Coverage | 1 | Generic | $7.00 | $14.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Signature |
$39.10 | $0 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier |
$39.30 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | $14.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$39.40 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $97.75 | $278.25 | Q:20 /31Days | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Plus |
$40.40 | $0 | No Gap Coverage | 4 | Tier 4 Non-Specialty Injectable | 33% | 33% | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$40.70 | $0 | No Gap Coverage | 2 | Tier 2 | $6.00 | $15.00 | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
UnitedHealth Rx Basic |
$41.90 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $98.00 | $279.00 | Q:20 /31Days | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-074 |
$43.80 | $295 | No Gap Coverage | 1 | Preferred Generic | 15% | 15% | None | |
Browse Plan Formulary | |||||||||
Health Net Value Orange Option 2 |
$46.70 | $0 | No Gap Coverage | 4 | Injectable | 33% | n/a | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold |
$51.00 | $0 | No Gap Coverage | 1 | Tier 1 Preferred Generics | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$52.80 | $50 | Many Generics | 2 | Generic | $9.00 | $23.00 | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier Plus |
$54.60 | $0 | Many Generics | 1 | Preferred Generic | $4.00 | $8.00 | None | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Aetna Medicare Rx Plus |
$61.60 | $0 | Some Generics | 2 | Tier 2 - Non-Preferred Generic | $10.00 | $20.00 | P Q:20 /5Days | |
Browse Plan Formulary | |||||||||
Community CCRx Gold |
$62.30 | $0 | All Generics | 1 | Generic | $5.00 | n/a | Q:20 /30Days | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Premier |
$70.70 | $0 | Many Generics | 4 | Tier 4 Non-Specialty Injectable | 33% | 33% | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$71.70 | $0 | Some Generics | 1 | Tier 1 | $6.00 | $15.00 | P | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$71.90 | $0 | Many Generics | 2 | Generic | $7.50 | $19.00 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum |
$73.60 | $0 | All Generics | 1 | Generic | $6.00 | $12.00 | Q:20 /30Days | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
AARP MedicareRx Enhanced |
$77.40 | $0 | Many Generics | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $95.00 | $270.00 | Q:20 /31Days | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-044 |
$95.00 | $0 | Many Generics | 1 | Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier |
$102.70 | $0 | Many Generics | 2 | Tier 2 - Non-Preferred Generic | $10.00 | $20.00 | P Q:20 /5Days | |
Browse Plan Formulary |
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