PROCRIT 4000U/ML VIAL 25 X 1ML VIAL (25 X 1 ML VIALSU) (NDC: 59676030402)
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 |
3 |
Tier 3 |
$85.00 | $245.00 | P Q:30 /31Days | $1,574.40 |
Browse Plan Formulary |
AARP MedicareComplete (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P Q:30 /31Days | $1,574.40 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$40.00 | $80.00 | P Q:12 /30Days | $1,592.32 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$40.00 | $80.00 | P Q:12 /30Days | $1,592.32 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,678.04 |
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 |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,678.04 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,723.81 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,723.81 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,597.09 |
Browse Plan Formulary |
Care1st Medicare Advantage Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,587.33 |
Browse Plan Formulary |
Care1st Medicare Advantage Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,587.33 |
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 |
4 |
Tier 4 |
$25.00 | $62.50 | P | $1,712.52 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,712.52 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $62.50 | P | $1,712.52 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $62.50 | P | $1,712.52 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $62.50 | P | $1,712.52 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $62.50 | P | $1,712.52 |
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 |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $62.50 | P | $1,712.52 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $100.00 | P Q:12 /28Days | $1,712.13 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $100.00 | P Q:12 /28Days | $1,712.13 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | P Q:12 /28Days | $1,587.78 |
Browse Plan Formulary |
Freedom Blue Plan I (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,677.25 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | P Q:30 /31Days | $1,572.55 |
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 |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $150.00 | P | n/a |
Browse Plan Formulary |
Inter Valley Health Plan Focus SNP (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$55.00 | $110.00 | P Q:12 /28Days | $1,712.13 |
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 |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:12 /28Days | $1,712.13 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P Q:12 /28Days | $1,712.13 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | n/a | P | $1,567.77 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | n/a | P | $1,567.77 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P | $1,573.78 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P | $1,573.78 |
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 |
2 |
Tier 2 |
$19.00 | $38.00 | P Q:12 /25Days | $1,583.71 |
Browse Plan Formulary |
MD Care Advantage 1 MAPD (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$19.00 | $38.00 | P Q:12 /25Days | $1,583.71 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$65.00 | $185.00 | P | $1,659.56 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$65.00 | $185.00 | P | $1,659.56 |
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 |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$35.00 | $87.50 | P | $1,712.52 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$14.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$14.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | P | $1,583.62 |
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 | P | $1,567.77 |
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 | P | $1,567.77 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.70 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$45.00 | $90.00 | P Q:12 /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 |
Aetna Medicare Premier Plan (HMO)
|
$21.70 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$45.00 | $90.00 | P Q:12 /30Days | n/a |
Browse Plan Formulary |
MD Care Preferred Dual SNP (HMO SNP)
|
$23.70 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P Q:12 /25Days | $1,583.49 |
Browse Plan Formulary |
MD Care Preferred Dual SNP (HMO SNP)
|
$23.70 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P Q:12 /25Days | $1,583.49 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $60.00 | P | $1,583.59 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $60.00 | P | $1,583.59 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$25.90 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P | $1,583.59 |
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)
|
$25.90 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P | $1,583.59 |
Browse Plan Formulary |
My Choice (HMO-POS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
$65.00 | $185.00 | P | $1,659.56 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,583.61 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,583.61 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,583.77 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,583.77 |
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 |
Central Health Medi-Medi Plan (HMO SNP)
|
$32.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:12 /28Days | $1,712.13 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$32.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:12 /28Days | $1,712.13 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$32.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,587.33 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$32.30 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P Q:12 /28Days | $1,587.33 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$32.30 |
$310 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | P | $1,659.56 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$33.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:12 /28Days | $1,588.24 |
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:12 /28Days | $1,588.24 |
Browse Plan Formulary |