ARIXTRA 7.5MG SYRINGE (10 X .6 ML SYR) (NDC: 00007323411)
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)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:19 /31Days | $1,237.99 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:19 /31Days | n/a |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:19 /31Days | n/a |
Browse Plan Formulary |
Advantage Health Florida (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /31Days | $1,238.06 |
Browse Plan Formulary |
Advantage Silver South (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /31Days | $1,239.15 |
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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,244.88 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | None | n/a |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | n/a |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$0.00 |
$130 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:18 /90Days | $1,222.42 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $0.00 | Q:14 /30Days | $1,223.47 |
Browse Plan Formulary |
CareOpen (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $0.00 | Q:14 /30Days | 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 Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,234.95 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,234.95 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,234.95 |
Browse Plan Formulary |
e-Any, Any, Any Gold Direct (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | None | n/a |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,241.42 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | P | $1,241.42 |
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 |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,241.15 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,241.15 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,241.15 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,241.15 |
Browse Plan Formulary |
Humana Gold Plus H1036-035A (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | Q:14 /30Days | $1,223.47 |
Browse Plan Formulary |
Humana Gold Plus H1036-062C (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:14 /30Days | $1,223.47 |
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 H5426-023 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.00 | $0.00 | Q:14 /30Days | n/a |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-130C (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:14 /30Days | $1,223.47 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $75.00 | None | $1,216.29 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | None | $1,216.29 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,216.29 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,216.29 |
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 Premier SNP - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,216.29 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Diabetes (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,216.29 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Institutional (HMO SNP)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,216.29 |
Browse Plan Formulary |
Molina Medicare Options Palm Beach, Hillsb & Pinel (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,244.49 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,240.26 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:19 /31Days | $1,240.06 |
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 |
PUP Rewards (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:19 /31Days | $1,240.06 |
Browse Plan Formulary |
Value One Florida (HMO SNP)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:19 /31Days | $1,238.06 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:8 /31Days | $1,250.11 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:8 /31Days | $1,247.60 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$13.90 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $110.00 | None | $1,216.29 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$16.10 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | $1,223.80 |
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 |
HumanaChoice H5415-056 (PPO)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:14 /30Days | n/a |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$20.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:8 /31Days | $1,247.80 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$20.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,217.22 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$23.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:8 /31Days | $1,248.19 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:14 /30Days | $1,223.47 |
Browse Plan Formulary |
CareNeeds Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:14 /30Days | $1,223.47 |
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 |
Evercare Plan IP (PPO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:19 /31Days | $1,238.23 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-104A (HMO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:14 /30Days | $1,223.47 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,243.25 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:14 /30Days | n/a |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:14 /30Days | $1,217.22 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$31.20 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:18 /90Days | $1,247.51 |
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 |
Aetna Medicare Standard Plan (PPO)
|
$36.00 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | $1,223.80 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$39.40 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:18 /90Days | $1,237.33 |
Browse Plan Formulary |