PROCRIT 40000U/ML VIAL PR (4 X 1 ML VIALSD) (NDC: 59676034001)
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 | 4 |
Tier 4 |
33% | 33% | P | $2,536.58 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,521.89 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,536.15 |
Browse Plan Formulary |
Advantage (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $2,520.36 |
Browse Plan Formulary |
Advantage Health Florida (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $2,521.21 |
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 | 4 |
Tier 4 |
33% | n/a | P | $2,519.38 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,534.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $120.00 | P Q:18 /90Days | n/a |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | P Q:18 /90Days | n/a |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$0.00 |
$130 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,509.37 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $2,497.84 |
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 |
CareOne Plus (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | n/a |
Browse Plan Formulary |
Citrus Total (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | n/a | P | $2,755.89 |
Browse Plan Formulary |
Coventry Advantra Ideal (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,512.54 |
Browse Plan Formulary |
Coventry Advantra Maximum (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,512.54 |
Browse Plan Formulary |
Coventry Advantra Plus (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,512.54 |
Browse Plan Formulary |
Coventry Advantra Select (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,512.54 |
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 |
e-Any, Any, Any Gold Direct (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $120.00 | P Q:18 /90Days | n/a |
Browse Plan Formulary |
e-Medicare Masterpiece Direct (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $115.00 | P Q:18 /90Days | 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 Q:18 /90Days | n/a |
Browse Plan Formulary |
Humana Gold Plus H1036-025 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $2,482.65 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | n/a |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$39.00 | $100.00 | P Q:18 /90Days | $2,474.04 |
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 (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $120.00 | P Q:18 /90Days | $2,474.04 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $50.00 | P Q:18 /90Days | $2,474.04 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - COPD (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $50.00 | P Q:18 /90Days | $2,474.04 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Dementia (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $50.00 | P Q:18 /90Days | $2,474.04 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Diabetes (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $50.00 | P Q:18 /90Days | $2,474.04 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Institutional (HMO SNP)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:18 /90Days | $2,474.04 |
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 Palm Beach, Hillsb & Pinel (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,532.45 |
Browse Plan Formulary |
Preferred Care Partners Preferred Gold Option (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | n/a |
Browse Plan Formulary |
Preferred Care Partners Preferred PremiumAdvantage (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,512.78 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,518.67 |
Browse Plan Formulary |
PUP Rewards (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,518.67 |
Browse Plan Formulary |
Value One Florida (HMO SNP)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,521.21 |
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 Choice (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $2,566.87 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $2,572.87 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $2,576.48 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$13.90 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $110.00 | P Q:18 /90Days | $2,474.04 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.40 |
$0 | to be determined | 5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | P | $2,553.82 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$20.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,549.07 |
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 |
HumanaChoice R5826-074 (Regional PPO)
|
$20.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $2,475.68 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO SNP)
|
$23.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $2,508.78 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$23.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,551.00 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$25.40 |
$310 | to be determined | 5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $2,507.16 |
Browse Plan Formulary |
CareNeeds Plus (HMO SNP)
|
$25.40 |
$310 | to be determined | 5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $2,497.84 |
Browse Plan Formulary |
Evercare Plan IP (PPO SNP)
|
$25.40 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,521.59 |
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)
|
$25.40 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,532.80 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | n/a |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $2,475.68 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$31.20 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,569.24 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$37.80 |
$0 | to be determined | 5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | P | $2,553.82 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$39.40 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,542.60 |
Browse Plan Formulary |