PROLEUKIN 1.1mg/mL 1 VIAL, SINGLE-USE in 1 BOX / 1 mL in 1 VIAL, SINGLE-USE (1 VIAL, SINGLE-USE in 1 B ) (NDC: 00078049561)
2012 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 | 5 |
Tier 5 |
33% | 33% | P | $1,173.20 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,222.38 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,222.38 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,206.87 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,220.15 |
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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $60.00 | None | $1,220.02 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,201.08 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,211.15 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,211.15 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,221.91 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,221.91 |
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 COPD (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,221.91 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,221.91 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,221.91 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,199.73 |
Browse Plan Formulary |
Healthy Advantage Plus (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,243.79 |
Browse Plan Formulary |
Healthy Advantage Refund (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,243.79 |
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 Plus H1036-054C (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,211.15 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,211.15 |
Browse Plan Formulary |
Humana Reader's Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,223.25 |
Browse Plan Formulary |
JacksonHealth for Life (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.92 |
Browse Plan Formulary |
JacksonHealth Secure (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,181.92 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | n/a | None | $1,293.95 |
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 |
Medica HealthCare Plans MedicareMax (PSO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Chronic Care (PSO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (PSO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,191.13 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,220.15 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,220.15 |
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 |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,220.15 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,208.29 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,221.91 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,221.91 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$320 | to be determined | 3 |
Tier 3 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Preferred Choice Dade (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | 20% | P | $1,184.44 |
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 |
Preferred Complete Care (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | 20% | P | $1,184.44 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,220.29 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $1,220.29 |
Browse Plan Formulary |
Preferred Premium Advantage Miami-Dade (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,184.44 |
Browse Plan Formulary |
Preferred Special Care Miami-Dade (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | 20% | P | $1,184.44 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,222.38 |
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% | P | $1,173.20 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,154.07 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,154.07 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,154.07 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,199.73 |
Browse Plan Formulary |
WellCare Choice (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,241.75 |
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 |
WellCare Dividend (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,241.75 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$1.10 |
$320 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $1,208.29 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$18.10 |
$320 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,233.76 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (PSO SNP)
|
$19.40 |
$320 | to be determined | 4 |
Tier 4 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$22.60 |
$320 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,211.15 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$23.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,208.29 |
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 |
CareNeeds (HMO SNP)
|
$23.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,211.15 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,211.15 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$23.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,211.15 |
Browse Plan Formulary |
MediMax (HMO)
|
$23.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,252.04 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$23.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,204.13 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$23.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,204.13 |
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 |
Simply Complete (HMO SNP)
|
$23.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,154.07 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,241.75 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,220.15 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,223.25 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$39.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,211.15 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$68.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,206.87 |
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)
|
$99.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,223.25 |
Browse Plan Formulary |