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 |
BCN Advantage Basic (HMO-POS)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
BCN Advantage Basic (HMO-POS)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
BCN Advantage Basic (HMO-POS)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
BCN Advantage Basic (HMO-POS)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
BCN Advantage Basic (HMO-POS)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 |
HAP Senior Plus - Henry Ford (HMO)
|
$7.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $112.50 | P | $1,282.54 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$10.80 |
$110 |
to be determined |
3 |
Tier 3 |
$45.00 | $112.50 | P | $1,297.79 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,239.76 |
Browse Plan Formulary |
HealthPlus MedicarePlus - AdvantageHMO Option 1 (HMO)
|
$16.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $1,277.43 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$19.20 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $112.50 | P | $1,297.79 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$20.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,231.18 |
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 |
BCN Advantage Option 2 (HMO-POS)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
BCN Advantage Option 2 (HMO-POS)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,268.00 |
Browse Plan Formulary |
BCN Advantage Option 2 (HMO-POS)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
BCN Advantage Option 2 (HMO-POS)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
BCN Advantage Option 2 (HMO-POS)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,218.77 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$22.70 |
$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 |
HumanaChoice R5826-006 (Regional PPO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:14 /30Days | $1,231.18 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$32.20 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | P | $1,282.54 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,239.76 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO SNP)
|
$34.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:19 /31Days | $1,235.63 |
Browse Plan Formulary |
Midwest Advantage (HMO SNP)
|
$34.70 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $1,244.52 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$34.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,244.56 |
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 |
CareSource Advantage (HMO SNP)
|
$36.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:30 /180Days | $1,312.70 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$40.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,244.56 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$46.30 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | P | $1,297.79 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$49.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,267.57 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$49.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$49.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
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 Plus Blue PPO Signature (PPO)
|
$49.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,218.77 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$49.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$49.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
HealthPlus MedicarePlus - AdvantageHMO Option 2 (HMO)
|
$50.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $1,277.43 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO SNP)
|
$52.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:19 /31Days | $1,235.63 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO SNP)
|
$56.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:19 /31Days | $1,235.63 |
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 |
Alliance Medicare PPO (PPO)
|
$66.30 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | P | $1,297.79 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$67.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$67.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$67.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$67.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$67.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 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 |
Medicare Plus Blue PPO Assure (PPO)
|
$67.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | n/a |
Browse Plan Formulary |
BCN Advantage Option 3 (HMO-POS)
|
$75.60 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,268.00 |
Browse Plan Formulary |
BCN Advantage Option 3 (HMO-POS)
|
$75.60 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
BCN Advantage Option 3 (HMO-POS)
|
$75.60 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |
BCN Advantage Option 3 (HMO-POS)
|
$75.60 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,218.77 |
Browse Plan Formulary |
BCN Advantage Option 3 (HMO-POS)
|
$75.60 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,192.49 |
Browse Plan Formulary |