ANDROGEL 1%(50MG) GEL PACKET (3O X 5GM PKT CRTN) (NDC: 00051845030)
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 Select Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$34.00 | $68.00 | None | $260.53 |
Browse Plan Formulary |
CareMore Breathe (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$60.00 | $120.00 | Q:300 /30Days | $285.83 |
Browse Plan Formulary |
CareMore Diabetes (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$60.00 | $120.00 | Q:300 /30Days | $285.83 |
Browse Plan Formulary |
CareMore Touch (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$60.00 | $120.00 | Q:300 /30Days | $285.83 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$60.00 | $120.00 | Q:300 /30Days | $285.83 |
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 Plus H2949-002 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | Q:300 /30Days | $258.52 |
Browse Plan Formulary |
Humana Gold Plus H2949-007 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.75 |
Browse Plan Formulary |
Humana Gold Plus H2949-012 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $259.94 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $259.94 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $259.94 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.09 |
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 |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.09 |
Browse Plan Formulary |
Senior Dimensions Northern Nevada Plan (HM
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:300 /30Days | $240.08 |
Browse Plan Formulary |
Senior Dimensions Southern Nevada Plan (HM
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:300 /30Days | $240.08 |
Browse Plan Formulary |
Senior Dimensions Southern Nevada Plan (HM
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:300 /30Days | $240.08 |
Browse Plan Formulary |
Senior Dimensions Southern Nevada Plan (HM
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:300 /30Days | $240.08 |
Browse Plan Formulary |
Sierra Nevada Spectrum (Regional PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:300 /30Days | $240.08 |
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 |
Sierra VillageHealth (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:300 /30Days | $240.08 |
Browse Plan Formulary |
Spectrum Care Plus (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:300 /30Days | $240.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
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 |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $278.91 |
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 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.77 |
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)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
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 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
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 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Anthem Medicare Preferred Premier (PPO)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $107.50 | P Q:300 /30Days | $278.98 |
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 |
Anthem Medicare Preferred Premier (PPO)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $107.50 | P Q:300 /30Days | $278.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.77 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$24.20 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $107.50 | P Q:300 /30Days | $278.98 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$24.20 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $107.50 | P Q:300 /30Days | $278.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $260.11 |
Browse Plan Formulary |
Aetna Medicare Select Plan (PPO)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$26.00 | $52.00 | None | $260.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.58 |
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 H2944-053 (PFFS)
|
$43.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.58 |
Browse Plan Formulary |
HumanaChoice H9503-001 (PPO)
|
$56.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $258.54 |
Browse Plan Formulary |