ARIXTRA 10MG SYRINGE (10 X .8 ML SYR) (NDC: 00007323611)
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% | Q:25 /31Days | $1,223.64 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:25 /31Days | $1,235.97 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:25 /31Days | $1,231.63 |
Browse Plan Formulary |
Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:25 /31Days | $1,233.45 |
Browse Plan Formulary |
Advantage Health Florida (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:25 /31Days | $1,234.64 |
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 Q:25 /31Days | $1,231.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,244.46 |
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:24 /90Days | $1,248.49 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | Q:14 /30Days | $1,211.75 |
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 |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | n/a |
Browse Plan Formulary |
Citrus Total (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | Q:24 /30Days | $1,266.28 |
Browse Plan Formulary |
Coventry Advantra Maximum (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,234.95 |
Browse Plan Formulary |
Coventry Advantra Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,234.95 |
Browse Plan Formulary |
Coventry Advantra Select (HMO-POS)
|
$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 |
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-Medicare Masterpiece Direct (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $115.00 | None | n/a |
Browse Plan Formulary |
e-Medicare Masterpiece Premier Direct (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | 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 | $1,246.13 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | P | $1,245.70 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,238.89 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,238.89 |
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 Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,238.89 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,238.89 |
Browse Plan Formulary |
Humana Gold Plus H1036-052 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | $1,225.69 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | Q:14 /30Days | n/a |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $100.00 | None | $1,171.30 |
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 |
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 (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 |
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 |
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 |
Optimum Gold Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,248.55 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,248.55 |
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 |
Preferred Care Partners Preferred Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | n/a |
Browse Plan Formulary |
Preferred Care Partners Preferred PremiumAdvantage (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.20 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:25 /31Days | $1,230.10 |
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 |
PUP Rewards (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:25 /31Days | $1,230.10 |
Browse Plan Formulary |
Value One Florida (HMO SNP)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:25 /31Days | $1,234.64 |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,237.41 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,237.41 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,235.84 |
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 |
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 |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | $1,231.19 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$20.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:11 /31Days | $1,245.36 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$20.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,217.15 |
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 | Q:14 /30Days | $1,201.12 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$23.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:11 /31Days | $1,246.62 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$78.00 | $224.00 | Q:14 /30Days | $1,201.12 |
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 |
CareNeeds Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | Q:14 /30Days | $1,211.75 |
Browse Plan Formulary |
Evercare Plan IP (PPO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:25 /31Days | $1,233.45 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,244.54 |
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 | $1,217.15 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$31.20 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:24 /90Days | $1,247.53 |
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)
|
$37.80 |
$0 |
to be determined |
5 |
Tier 5: Specialty Tier Drugs |
33% | 33% | None | $1,231.19 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$39.40 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:24 /90Days | $1,234.78 |
Browse Plan Formulary |