AMEVIVE ADMISTRATION PACK FOR INTRAMUSCULAR ADMINISTRATION KIT 15MG 1 X 4 PKGCOM (1 X 4 PKGCOM) (NDC: 00469002103)
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 Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $4,507.35 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$65.00 | $195.00 | P | $4,505.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,466.72 |
Browse Plan Formulary |
Humana Gold Plus H0307-011 (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
SCAN Health Plan Arizona (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $3,881.01 |
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 |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
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 |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,659.75 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,668.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $4,553.27 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $4,588.35 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$15.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,466.72 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,466.72 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,466.72 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,466.72 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,466.72 |
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 |
5 |
Tier 5 |
33% | n/a | P | $4,466.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
Browse Plan Formulary |
Humana Gold Plus H0307-008 (HMO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Plus H0307-010 (HMO-POS)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Mercy Care Advantage (HMO)
|
$19.60 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $3,841.82 |
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 Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
3 |
Tier 3 |
$6.30 | $6.30 | P | $3,824.02 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
3 |
Tier 3 |
$6.30 | $6.30 | P | $3,824.02 |
Browse Plan Formulary |
Health Net Amber (HMO)
|
$24.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $4,466.72 |
Browse Plan Formulary |
Abrazo Advantage Plus (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | n/a | P | $3,826.70 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$24.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,668.52 |
Browse Plan Formulary |
Abrazo Advantage (HMO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | $3,826.70 |
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 |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-030 (PFFS)
|
$33.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
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 H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
HumanaChoice R5826-076 (Regional PPO)
|
$34.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
HumanaChoice H0317-002 (PPO)
|
$36.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
HumanaChoice R5826-014 (Regional PPO)
|
$38.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,553.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
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 |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,713.81 |
Browse Plan Formulary |
HumanaChoice H0317-001 (PPO)
|
$50.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /30Days | $4,093.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $4,588.35 |
Browse Plan Formulary |