PROCRIT 4000U/ML VIAL 25 X 1ML VIAL (25 X 1 ML VIALSU) (NDC: 59676030402)
2010 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 |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
First Health Part D-Secure (PDP)
|
$19.80 |
$175 |
No Gap Coverage |
3 |
Non-Preferred Generic and Non-Preferred Brand |
44% | 44% | P Q:12 /28Days | $1,570.73 |
Browse Plan Formulary |
Fox Value Plan (PDP)
|
$23.10 |
$310 |
No Gap Coverage |
3 |
Tier 3 |
40% | 30% | P Q:12 /28Days | n/a |
Browse Plan Formulary |
PrescribaRx Bronze (PDP)
|
$23.60 |
$310 |
No Gap Coverage |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,602.85 |
Browse Plan Formulary |
Advantage Star Plan by RxAmerica (PDP)
|
$24.20 |
$310 |
No Gap Coverage |
2 |
Preferred Brand |
25% | 25% | P Q:12 /28Days | $1,587.91 |
Browse Plan Formulary |
Humana Value S5884-105 (PDP)
|
$24.20 |
$150 |
No Gap Coverage |
3 |
Non-Preferred Brand |
35% | 35% | P Q:14 /30Days | $1,559.63 |
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 |
Health Net Orange Option 1 (PDP)
|
$25.70 |
$310 |
No Gap Coverage |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | P | $1,581.61 |
Browse Plan Formulary |
EnvisionRxPlus Silver (PDP)
|
$26.50 |
$310 |
No Gap Coverage |
3 |
Tier 3 |
25% | 25% | P Q:12 /30Days | $1,627.50 |
Browse Plan Formulary |
MedicareRx Rewards Plus (PDP)
|
$26.90 |
$0 |
No Gap Coverage |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | P | $1,661.12 |
Browse Plan Formulary |
Community CCRx Basic (PDP)
|
$33.60 |
$310 |
No Gap Coverage |
2 |
Preferred Brand |
25% | n/a | P Q:12 /28Days | $1,597.50 |
Browse Plan Formulary |
AARP MedicareRx Saver (PDP)
|
$34.10 |
$310 |
No Gap Coverage |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$82.75 | $233.25 | P Q:30 /31Days | $1,580.79 |
Browse Plan Formulary |
AARP MedicareRx Preferred (PDP)
|
$35.10 |
$0 |
No Gap Coverage |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$68.50 | $190.50 | P Q:30 /31Days | $1,580.79 |
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 |
MedicareRx Rewards Standard (PDP)
|
$35.30 |
$310 |
No Gap Coverage |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P | $1,661.12 |
Browse Plan Formulary |
AdvantraRx Value (PDP)
|
$35.90 |
$100 |
No Gap Coverage |
3 |
Non-Preferred Generic and Non-Preferred Brand |
66% | 66% | P Q:12 /28Days | $1,570.73 |
Browse Plan Formulary |
HealthSpring Prescription Drug Plan-Reg 11
|
$36.80 |
$310 |
No Gap Coverage |
2 |
Tier 2 |
25% | 25% | P | $1,587.22 |
Browse Plan Formulary |
Medco Medicare Prescription Plan - Value (
|
$37.40 |
$310 |
No Gap Coverage |
2 |
Tier 2 |
25% | 25% | P Q:36 /90Days | $1,571.29 |
Browse Plan Formulary |
Sterling Rx (PDP)
|
$37.60 |
$310 |
No Gap Coverage |
2 |
Brand |
$30.00 | $60.00 | P | $1,647.04 |
Browse Plan Formulary |
PrescribaRx Gold (PDP)
|
$37.70 |
$150 |
No Gap Coverage |
2 |
Brand |
$43.00 | $86.00 | P Q:12 /28Days | $1,602.85 |
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 Rx Costco Plus Plan (PDP)
|
$37.90 |
$0 |
No Gap Coverage |
3 |
Tier 3 - Preferred Brand |
$33.00 | $99.00 | P | $1,596.22 |
Browse Plan Formulary |
First Health Part D-Premier (PDP)
|
$37.90 |
$150 |
No Gap Coverage |
3 |
Non-Preferred Generic/Non-Preferred Brand |
41% | 41% | P Q:12 /28Days | $1,570.73 |
Browse Plan Formulary |
Community CCRx Choice (PDP)
|
$39.10 |
$150 |
No Gap Coverage |
2 |
Preferred Brand |
$35.00 | n/a | P Q:12 /28Days | $1,597.50 |
Browse Plan Formulary |
CIGNA Medicare Rx Plan Two (PDP)
|
$39.30 |
$100 |
No Gap Coverage |
3 |
Tier 3 |
$35.00 | $87.50 | P Q:12 /28Days | $1,590.96 |
Browse Plan Formulary |
UA Medicare Part D Rx Covg - Silver Plan (
|
$41.70 |
$145 |
No Gap Coverage |
2 |
Preferred Brand |
$45.00 | $113.00 | P Q:36 /90Days | $1,571.20 |
Browse Plan Formulary |
CIGNA Medicare Rx Plan One (PDP)
|
$42.00 |
$310 |
No Gap Coverage |
2 |
Tier 2 |
$29.00 | $72.50 | P Q:12 /28Days | $1,590.96 |
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 |
Humana Enhanced S5884-010 (PDP)
|
$42.60 |
$0 |
No Gap Coverage |
3 |
Non-Preferred Brand |
$76.00 | $190.00 | P Q:14 /30Days | $1,559.63 |
Browse Plan Formulary |
BlueMedicare Rx-Option 3 (PDP)
|
$44.50 |
$300 |
No Gap Coverage |
3 |
Tier 3 - Covered Brand |
$70.00 | $140.00 | P | $1,622.12 |
Browse Plan Formulary |
AdvantraRx Premier (PDP)
|
$44.60 |
$0 |
No Gap Coverage |
3 |
Non-Preferred Generic and Non-Preferred Brand |
55% | 55% | P Q:12 /28Days | $1,570.73 |
Browse Plan Formulary |
Advantage Freedom Plan by RxAmerica (PDP)
|
$45.90 |
$0 |
No Gap Coverage |
3 |
Preferred Brand |
33% | 33% | P Q:12 /28Days | $1,585.88 |
Browse Plan Formulary |
Fox Grand Plan (PDP)
|
$47.50 |
$0 |
Some Generics |
3 |
Tier 3 |
$41.00 | $82.00 | P Q:12 /28Days | n/a |
Browse Plan Formulary |
SilverScript Value (PDP)
|
$49.00 |
$310 |
No Gap Coverage |
2 |
Preferred Brand Tier |
$25.50 | $63.75 | P | $1,583.88 |
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 |
Medco Medicare Prescription Plan - Choice
|
$49.10 |
$100 |
No Gap Coverage |
2 |
Preferred Brand |
$40.00 | $100.00 | P Q:36 /90Days | $1,571.29 |
Browse Plan Formulary |
UA Medicare Part D Prescription Drug Cov (
|
$52.00 |
$0 |
No Gap Coverage |
2 |
Preferred Brand |
$38.00 | $76.00 | P Q:36 /90Days | $1,571.20 |
Browse Plan Formulary |
Quality Rx (PDP)
|
$55.30 |
$310 |
No Gap Coverage |
3 |
Tier 3 |
25% | 25% | P Q:12 /30Days | $1,608.10 |
Browse Plan Formulary |
CVS Caremark Plus (PDP)
|
$56.30 |
$50 |
No Gap Coverage |
4 |
Preferred Brand Tier |
$30.00 | $75.00 | P | $1,581.94 |
Browse Plan Formulary |
CIGNA Medicare Rx Plan Three (PDP)
|
$59.10 |
$0 |
Many Generics, Few Brands |
2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,590.96 |
Browse Plan Formulary |
CVS Caremark Complete (PDP)
|
$59.50 |
$0 |
Many Generics |
3 |
Preferred Brand Tier |
$39.00 | $98.00 | P | $1,581.94 |
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 |
AdvantraRx Premier Plus (PDP)
|
$60.60 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
75% | 75% | P Q:12 /28Days | $1,570.73 |
Browse Plan Formulary |
EnvisionRxPlus Gold (PDP)
|
$63.70 |
$150 |
No Gap Coverage |
3 |
Tier 3 Preferred Brand |
$25.00 | $75.00 | P Q:12 /30Days | $1,627.50 |
Browse Plan Formulary |
Aetna Medicare Rx Essentials (PDP)
|
$65.20 |
$310 |
No Gap Coverage |
3 |
Tier 3 - Preferred Brand |
$27.00 | $66.00 | P | $1,596.22 |
Browse Plan Formulary |
BlueMedicare Rx-Option 1 (PDP)
|
$72.00 |
$0 |
No Gap Coverage |
3 |
Tier 3 - Covered Brand |
$70.00 | $140.00 | P | $1,622.12 |
Browse Plan Formulary |
AARP MedicareRx Enhanced (PDP)
|
$72.50 |
$0 |
Many Generics |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$90.00 | $255.00 | P Q:30 /31Days | $1,580.79 |
Browse Plan Formulary |
Community CCRx Gold (PDP)
|
$72.90 |
$0 |
All Generics |
2 |
Preferred Brand |
$35.00 | n/a | P Q:12 /28Days | $1,597.50 |
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 |
Health Net Orange Option 2 (PDP)
|
$74.10 |
$0 |
No Gap Coverage |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | P | $1,581.61 |
Browse Plan Formulary |
Quality Rx Plus (PDP)
|
$74.10 |
$150 |
No Gap Coverage |
3 |
Tier 3 Preferred Brand |
$25.00 | $75.00 | P Q:12 /30Days | $1,608.10 |
Browse Plan Formulary |
Medco Medicare Prescription Plan - Access
|
$76.90 |
$0 |
Many Generics |
2 |
Preferred Brand |
$40.00 | $100.00 | P Q:36 /90Days | $1,571.29 |
Browse Plan Formulary |
Aetna Medicare Rx Premier (PDP)
|
$90.90 |
$0 |
Many Generics |
3 |
Tier 3 - Preferred Brand |
$36.00 | $93.00 | P | $1,596.22 |
Browse Plan Formulary |
BlueMedicare Rx-Option 2 (PDP)
|
$99.00 |
$0 |
Many Generics |
3 |
Tier 3 - Covered Brand |
$70.00 | $140.00 | P | $1,622.12 |
Browse Plan Formulary |
Humana Complete S5884-039 (PDP)
|
$100.40 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$75.00 | $187.50 | P Q:14 /30Days | $1,559.63 |
Browse Plan Formulary |