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 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 Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P | $1,310.85 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$19.00 | $47.00 | P | $1,310.85 |
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 |
Advantage Silver South (HMO)
|
$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 |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | 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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | P | $1,320.39 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$35.00 | $95.00 | None | $1,228.63 |
Browse Plan Formulary |
CareFree Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$84.00 | $242.00 | 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 |
CareOne Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $1,228.63 |
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 |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $1,295.37 |
Browse Plan Formulary |
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 |
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 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 H1036-034A (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $200.00 | None | $1,228.63 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $1,228.63 |
Browse Plan Formulary |
Humana Gold Plus H5426-021 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $260.00 | None | n/a |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-125C (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$35.00 | $95.00 | None | $1,228.63 |
Browse Plan Formulary |
JacksonHealth for Life (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P | $1,324.83 |
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 |
JacksonHealth Success (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P | $1,324.83 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | P | $1,327.19 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (PSO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$10.00 | n/a | None | $1,327.15 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (PSO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | n/a | None | $1,327.15 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $75.00 | P | $1,324.78 |
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 |
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 - 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 |
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 Miami-Dade & Broward Co. (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P | $1,303.10 |
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 |
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 Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,295.37 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $80.00 | P | $1,310.85 |
Browse Plan Formulary |
PUP Rewards (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $110.00 | 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)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P | $1,291.66 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.00 | P | $1,291.66 |
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 Plus (HMO-POS)
|
$13.90 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $110.00 | P | $1,309.22 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$16.10 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$40.00 | $80.00 | P | $1,292.01 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
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 |
Medica HealthCare Plans MedicareMax Plus (PSO SNP)
|
$23.30 |
$310 |
to be determined |
4 |
Tier 4 |
35% | n/a | None | $1,327.15 |
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 Select (HMO-POS SNP)
|
$23.30 |
$310 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P | $1,327.75 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$24.30 |
$310 |
to be determined |
4 |
Tier 4 |
$79.00 | $227.00 | None | $1,228.63 |
Browse Plan Formulary |
CareNeeds Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$81.00 | $233.00 | None | $1,228.63 |
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 |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$73.00 | $209.00 | None | $1,228.63 |
Browse Plan Formulary |
JacksonHealth Secure (HMO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | $1,324.83 |
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 |
2 |
Tier 2 |
$45.00 | $135.00 | P | $1,303.10 |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,310.85 |
Browse Plan Formulary |
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)
|
$36.00 |
$0 |
to be determined |
3 |
Tier 3: Preferred Brand Drugs |
$40.00 | $80.00 | P | $1,292.01 |
Browse Plan Formulary |