INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG (500 ML BAG) (NDC: 00338052003)
2010 Medicare Prescription Drug Plan (MAPD) 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 |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,019.73 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,019.73 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,019.73 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,019.73 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,019.73 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,019.73 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,019.73 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$27.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$27.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Select (HMO)
|
$34.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Bravo Select (HMO)
|
$34.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $170.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $170.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $170.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $170.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $170.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $170.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $170.00 | None | $1,031.41 |
Browse Plan Formulary |