ARIXTRA 10MG SYRINGE (10 X .8 ML SYR) (NDC: 00007323611)
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 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:25 /31Days | $1,238.19 |
Browse Plan Formulary |
AARP MedicareComplete (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:25 /31Days | $1,238.19 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | $1,237.69 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | $1,237.69 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,324.52 |
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 |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,324.52 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | 33% | Q:24 /30Days | $1,366.75 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | 33% | Q:24 /30Days | $1,366.75 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | 33% | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Care1st Medicare Advantage Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,243.71 |
Browse Plan Formulary |
Care1st Medicare Advantage Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,243.71 |
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 |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | P Q:24 /30Days | $1,354.86 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$310 |
to be determined |
6 |
Tier 6 |
25% | n/a | P Q:24 /30Days | $1,354.86 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | P Q:24 /30Days | $1,354.86 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | P Q:24 /30Days | $1,354.86 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | P Q:24 /30Days | $1,354.86 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
25% | n/a | P Q:24 /30Days | $1,354.86 |
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 |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | P Q:24 /30Days | $1,354.86 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | 33% | P Q:24 /30Days | $1,356.74 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | 33% | P Q:24 /30Days | $1,356.74 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:11 /28Days | $1,243.22 |
Browse Plan Formulary |
Freedom Blue Plan I (Regional PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:25 /31Days | $1,237.01 |
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 |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Inter Valley Health Plan Focus SNP (HMO SNP)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
25% | n/a | P | $1,356.74 |
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 |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,356.74 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,356.74 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | n/a | None | $1,096.22 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | n/a | None | $1,096.22 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,102.53 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,102.53 |
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 |
MD Care Advantage 1 MAPD (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:30 /180Days | $1,245.86 |
Browse Plan Formulary |
MD Care Advantage 1 MAPD (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:30 /180Days | $1,245.86 |
Browse Plan Formulary |
POSITIVE HEALTHCARE PARTNERS (HMO SNP)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | P Q:24 /24Days | $1,265.37 |
Browse Plan Formulary |
POSITIVE HEALTHCARE PARTNERS (HMO SNP)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | P Q:24 /24Days | $1,265.37 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
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 |
SCAN Classic (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,307.38 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,307.38 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | P Q:24 /30Days | $1,354.86 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$14.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$14.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$17.80 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | n/a | None | $1,096.22 |
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 |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$17.80 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | n/a | None | $1,096.22 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.70 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | n/a |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.70 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | n/a |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,244.74 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,244.74 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$25.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,244.74 |
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)
|
$25.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,244.74 |
Browse Plan Formulary |
My Choice (HMO-POS)
|
$27.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,307.38 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$32.30 |
$310 |
to be determined |
6 |
Tier 6 |
25% | 25% | P Q:24 /30Days | $1,356.74 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$32.30 |
$310 |
to be determined |
6 |
Tier 6 |
25% | 25% | P Q:24 /30Days | $1,356.74 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$32.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:11 /28Days | $1,243.71 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$32.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | n/a | None | $1,307.38 |
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 |
Brand New Day (HMO SNP)
|
$33.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:11 /28Days | $1,240.27 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$33.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:11 /28Days | $1,240.27 |
Browse Plan Formulary |