ACTIMMUNE SOLUTION FOR INJECTION 100MCG (12 X 0.5 ML CRTN) (NDC: 64116001112)
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 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $4,841.31 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $4,841.31 |
Browse Plan Formulary |
Anthem Medicare Preferred Core (PPO)
|
$0.00 |
$60* |
to be determined |
5* |
Tier 5 |
33% | n/a | P | $3,993.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,639.82 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,529.38 |
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 |
Care Improvement Plus Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,529.38 |
Browse Plan Formulary |
Coventry Total Care (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,550.52 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,847.61 |
Browse Plan Formulary |
Gold Advantage Option 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,550.52 |
Browse Plan Formulary |
Gold Advantage Option II (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,550.52 |
Browse Plan Formulary |
Humana Gold Plus H2649-023 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,650.40 |
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 |
Universal Hassle-Free (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,639.82 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,719.85 |
Browse Plan Formulary |
Advantra (PPO)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,550.52 |
Browse Plan Formulary |
Advantra Option 1 (HMO)
|
$27.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,550.52 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$28.10 |
$320 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,719.85 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,594.66 |
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 |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
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 |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | P | $4,853.40 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$28.90 |
$215 |
to be determined |
4 |
Tier 4 |
27% | 27% | None | $4,529.38 |
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 |
Care Improvement Plus Silver Rx (Regional PPO SNP)
|
$31.80 |
$150 |
to be determined |
4 |
Tier 4 |
29% | 29% | None | $4,529.38 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
|
$31.90 |
$240 |
to be determined |
4 |
Tier 4 |
27% | 27% | None | $4,529.38 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$32.10 |
$155 |
to be determined |
4 |
Tier 4 |
29% | 29% | None | $4,529.38 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$32.10 |
$205 |
to be determined |
4 |
Tier 4 |
27% | 27% | None | $4,529.38 |
Browse Plan Formulary |
Humana Gold Choice H8145-125 (PFFS)
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,650.40 |
Browse Plan Formulary |
HumanaChoice R5826-010 (Regional PPO)
|
$35.20 |
$320 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,650.40 |
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 |
Care Improvement Plus Medicare Advantage (PPO)
|
$38.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,529.38 |
Browse Plan Formulary |
HumanaChoice H1716-020 (PPO)
|
$39.00 |
$320 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $4,650.40 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$42.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $4,841.31 |
Browse Plan Formulary |
Essence Advantage Plus (HMO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,847.61 |
Browse Plan Formulary |
WindsorSterling Gold Plus Plan (PPO)
|
$50.00 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,594.66 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
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 |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,594.66 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
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 |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $4,853.40 |
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 H1716-006 (PPO)
|
$73.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,650.40 |
Browse Plan Formulary |
Advantra Option 2 (HMO-POS)
|
$88.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,550.52 |
Browse Plan Formulary |
HumanaChoice H1716-019 (PPO)
|
$122.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,650.40 |
Browse Plan Formulary |