AMIFOSTINE FOR INJECTION 500MG/VIAL (3 X 10ML VIALSU) (NDC: 62756058142)
2011 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional 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 Choice Plan 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Choice Plan 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Advantage Health Florida (HMO SNP)
![Email Prescription and/or Health Benefit details for Advantage Health Florida (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Advantage Silver South (HMO)
![Email Prescription and/or Health Benefit details for Advantage Silver South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$4.00 | $8.00 | P | $1,296.78 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | n/a |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,161.01 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
CareDirect (HMO SNP)
![Email Prescription and/or Health Benefit details for CareDirect (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,803.12 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareFree Plus (HMO)
![Email Prescription and/or Health Benefit details for CareFree Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | n/a |
Browse Plan Formulary |
CareOne Plus (HMO)
![Email Prescription and/or Health Benefit details for CareOne Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,803.12 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
![Email Prescription and/or Health Benefit details for Coventry Summit Ideal (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
![Email Prescription and/or Health Benefit details for Coventry Summit Maximum (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
![Email Prescription and/or Health Benefit details for Coventry Summit Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
![Email Prescription and/or Health Benefit details for Coventry Vista Ideal (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Coventry Vista Maximum (HMO SNP)
![Email Prescription and/or Health Benefit details for Coventry Vista Maximum (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
![Email Prescription and/or Health Benefit details for Coventry Vista Maximum Choice (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
e-Any, Any, Any Gold Direct (PFFS)
![Email Prescription and/or Health Benefit details for e-Any, Any, Any Gold Direct (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Humana Gold Plus H1036-034A (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-034A (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,803.12 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-054C (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,803.12 |
Browse Plan Formulary |
Humana Gold Plus H5426-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DB H1036-125C (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DB H1036-125C (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,803.12 |
Browse Plan Formulary |
JacksonHealth for Life (HMO)
![Email Prescription and/or Health Benefit details for JacksonHealth for Life (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,408.91 |
Browse Plan Formulary |
JacksonHealth Success (HMO SNP)
![Email Prescription and/or Health Benefit details for JacksonHealth Success (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,408.91 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
![Email Prescription and/or Health Benefit details for Leon Medical Centers Health Plans - Leon Cares (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | n/a | None | $2.25 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (PSO)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax (PSO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | None | $1,502.73 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (PSO)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Value RX (PSO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,502.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,396.91 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,396.91 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - COPD (HMO SNP)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier SNP - COPD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,396.91 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Dementia (HMO SNP)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier SNP - Dementia (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,396.91 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier SNP - Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,396.91 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Institutional (HMO SNP)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier SNP - Institutional (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,396.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options Miami-Dade & Broward Co. (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Miami-Dade & Broward Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | n/a |
Browse Plan Formulary |
POSITIVE HEALTHCARE PARTNERS (HMO SNP)
![Email Prescription and/or Health Benefit details for POSITIVE HEALTHCARE PARTNERS (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | P | n/a |
Browse Plan Formulary |
Preferred Care Partners Preferred Choice Dade (HMO-POS)
![Email Prescription and/or Health Benefit details for Preferred Care Partners Preferred Choice Dade (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | n/a |
Browse Plan Formulary |
Preferred Care Partners Preferred Complete Care (HMO)
![Email Prescription and/or Health Benefit details for Preferred Care Partners Preferred Complete Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | n/a |
Browse Plan Formulary |
Preferred Care Partners Preferred Medicare Assist (HMO SNP)
![Email Prescription and/or Health Benefit details for Preferred Care Partners Preferred Medicare Assist (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | n/a |
Browse Plan Formulary |
Preferred Care Partners Preferred PremiumAdvantage (HMO-POS)
![Email Prescription and/or Health Benefit details for Preferred Care Partners Preferred PremiumAdvantage (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Preferred Care Partners Preferred Special Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Preferred Care Partners Preferred Special Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | n/a |
Browse Plan Formulary |
PUP Easy (HMO)
![Email Prescription and/or Health Benefit details for PUP Easy (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
PUP Rewards (HMO)
![Email Prescription and/or Health Benefit details for PUP Rewards (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
![Email Prescription and/or Health Benefit details for SunPlus Advantage Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Value One Florida (HMO SNP)
![Email Prescription and/or Health Benefit details for Value One Florida (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
WellCare Choice (HMO)
![Email Prescription and/or Health Benefit details for WellCare Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WellCare Dividend (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | n/a |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$13.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,396.91 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.10 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | P | $1,309.79 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5415-056 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | n/a |
Browse Plan Formulary |
WellCare Access (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Access (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.30 |
$310 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | n/a |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-074 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica HealthCare Plans MedicareMax Plus (PSO SNP)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Plus (PSO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | n/a | None | $1,502.73 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for WellCare Select (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$310 |
to be determined |
1 |
Tier 1 |
$3.00 | $7.00 | P | n/a |
Browse Plan Formulary |
CareNeeds (HMO SNP)
![Email Prescription and/or Health Benefit details for CareNeeds (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,803.12 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
![Email Prescription and/or Health Benefit details for Amerivantage Specialty + Rx (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | $1,296.78 |
Browse Plan Formulary |
CareNeeds Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for CareNeeds Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$310 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,803.12 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-077A (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$310 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$310* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | n/a |
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Humana Gold Choice H8145-061 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-061 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | n/a |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-005 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,803.12 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Regional PPO (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.20 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
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Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | P | $1,309.79 |
Browse Plan Formulary |