AMINOSYN II 15% IV SOLUTION (6 X 2000 ML CTR) (NDC: 00409712207)
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 |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $359.41 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $120.00 | P | $361.54 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $355.53 |
Browse Plan Formulary |
Humana Gold Plus H0307-011 (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $355.50 |
Browse Plan Formulary |
SCAN Health Plan Arizona (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$28.00 | $56.00 | None | $309.00 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
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)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $365.44 |
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 |
Desert Canyon Community Care - Plus (HMO)
|
$8.80 |
$0 |
to be determined |
3 |
Tier 3 |
$44.00 | $88.00 | P | $354.33 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx-Dual (HMO)
|
$9.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $361.54 |
Browse Plan Formulary |
Desert Canyon Community Care - Plus Point
|
$11.60 |
$0 |
to be determined |
3 |
Tier 3 |
$44.00 | $88.00 | P | $354.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $341.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $351.96 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $355.53 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $355.53 |
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 Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $355.53 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $355.53 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $355.53 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $355.53 |
Browse Plan Formulary |
SCAN Health Plan Arizona (HMO)
|
$16.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $309.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $351.96 |
Browse Plan Formulary |
Humana Gold Plus H0307-008 (HMO)
|
$19.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Plus H0307-010 (HMO-POS)
|
$19.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Maricopa Care Advantage (HMO)
|
$19.60 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $304.21 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $341.16 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.30 | $6.30 | None | $304.21 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.30 | $6.30 | None | $304.21 |
Browse Plan Formulary |
Health Net Amber (HMO)
|
$24.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $355.53 |
Browse Plan Formulary |
ONECare by Care1st Health Plan Arizona, In
|
$24.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | n/a | P | $373.80 |
Browse Plan Formulary |
Abrazo Advantage Plus (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | n/a | None | $304.21 |
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 |
APIPA Personal Care Plus (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $371.10 |
Browse Plan Formulary |
Abrazo Advantage (HMO)
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $120.00 | None | $304.21 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
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 |
Humana Gold Choice H2944-030 (PFFS)
|
$33.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
HumanaChoice R5826-076 (Regional PPO)
|
$34.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $355.50 |
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 |
HumanaChoice H0317-002 (PPO)
|
$36.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
HumanaChoice R5826-014 (Regional PPO)
|
$38.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |
HumanaChoice H0317-001 (PPO)
|
$50.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $355.50 |
Browse Plan Formulary |