AMIFOSTINE FOR INJECTION 500MG/VIAL (3 X 10ML VIALSU) (NDC: 62756058142)
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 |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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 |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
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 |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
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 |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $1,266.94 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $1,266.94 |
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 |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $1,266.94 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $1,266.94 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $1,266.94 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $1,266.94 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $1,266.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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 |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$27.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$27.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
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 |
AmeriChoice Personal Care Plus (HMO)
|
$31.20 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
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 |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Horizon Medicare Blue Value w/ Rx Std (HMO
|
$40.40 |
$310 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $1,334.73 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Horizon Medicare Blue Value w/ Rx Enhanced
|
$66.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $1,334.73 |
Browse Plan Formulary |
Horizon Medicare Blue Access w/ Rx Std (HM
|
$67.10 |
$310 |
to be determined |
1 |
Tier 1 |
$10.00 | $15.00 | None | $1,334.73 |
Browse Plan Formulary |
Horizon Medicare Blue Access w/Rx Enhanced
|
$77.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $1,334.73 |
Browse Plan Formulary |