HECTOROL 4 MCG/2ML AMPUL (NDC: 58468012201)
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 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,295.26 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,307.07 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,295.26 |
Browse Plan Formulary |
Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | P | n/a |
Browse Plan Formulary |
Advantage Health Florida (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | 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 |
Advantage Silver (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | P | n/a |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P | $1,303.06 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | P | n/a |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | n/a |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | None | $1,543.88 |
Browse Plan Formulary |
CareOne Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | 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 |
Citrus Total (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $192.00 | None | $1,319.23 |
Browse Plan Formulary |
e-Any, Any, Any Gold Direct (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | P | n/a |
Browse Plan Formulary |
e-Medicare Masterpiece Direct (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $115.00 | P | n/a |
Browse Plan Formulary |
e-Medicare Masterpiece Premier Direct (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | n/a |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,295.37 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | P | $1,295.37 |
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 | $1,295.37 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,295.37 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,295.37 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,295.37 |
Browse Plan Formulary |
Humana Gold Plus H1036-052 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | 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 Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $100.00 | P | $1,297.69 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | P | $1,309.22 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | $1,309.22 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | $1,321.00 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | $1,321.00 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Diabetes (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | $1,321.00 |
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 - Institutional (HMO SNP)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,309.22 |
Browse Plan Formulary |
Molina Medicare Options Palm Beach, Hillsb & Pinel (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $90.00 | P | $1,367.08 |
Browse Plan Formulary |
Optimum Gold Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,295.37 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,295.37 |
Browse Plan Formulary |
Optimum Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | P | n/a |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $1,347.07 |
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 |
3 |
Tier 3 |
$35.00 | $70.00 | P | $1,347.07 |
Browse Plan Formulary |
Value One Florida (HMO SNP)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | n/a |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.00 | P | $1,327.75 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.00 | P | $1,327.75 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P | $1,306.63 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$13.90 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $110.00 | P | $1,309.22 |
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 |
Aetna Medicare Value Plan (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$45.00 | $90.00 | P | $1,322.38 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$20.30 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | P | $1,295.29 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$20.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,352.10 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO SNP)
|
$23.30 |
$310 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | None | $1,543.88 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$23.30 |
$310 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P | $1,327.75 |
Browse Plan Formulary |
Evercare Plan DH (HMO SNP)
|
$23.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,295.26 |
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 DH (HMO SNP)
|
$24.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,295.26 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$78.00 | $224.00 | None | $1,543.88 |
Browse Plan Formulary |
CareNeeds Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | None | $1,543.88 |
Browse Plan Formulary |
Evercare Plan IP (PPO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,295.26 |
Browse Plan Formulary |
Evercare Plan RDP (Regional PPO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,307.07 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P | $1,303.10 |
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 Choice H8145-061 (PFFS)
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,352.10 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$40.00 | $80.00 | P | $1,322.38 |
Browse Plan Formulary |