ARIXTRA 10MG SYRINGE (10 X .8 ML SYR) (NDC: 00007323611)
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 (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,232.74 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,236.21 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,233.15 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $220.00 | None | $1,235.12 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:24 /90Days | $1,222.18 |
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 |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | $1,218.48 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | $1,218.48 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | Q:14 /30Days | $1,221.65 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | $1,218.48 |
Browse Plan Formulary |
Citrus Total (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,232.76 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,243.74 |
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 Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | P | $1,242.24 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
Browse Plan Formulary |
Humana Gold Plus H1036-025 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | $1,177.93 |
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 H1036-141 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | $1,221.43 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-160 (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:14 /30Days | $1,221.41 |
Browse Plan Formulary |
Humana Reader's Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | Q:14 /30Days | $1,224.95 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $200.00 | None | $1,235.12 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $200.00 | None | $1,235.12 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $1,235.12 |
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 |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $1,235.12 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $1,235.12 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $1,235.12 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | P | $1,247.69 |
Browse Plan Formulary |
Optimum Diamond Rewards COPD (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | P | $1,247.69 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,246.04 |
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 |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,246.04 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
Browse Plan Formulary |
Preferred Select Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
Browse Plan Formulary |
PUP PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:25 /31Days | $1,230.78 |
Browse Plan Formulary |
PUP SIMPLE (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:25 /31Days | $1,230.78 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $75.00 | Q:25 /31Days | $1,241.56 |
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 |
Simply More (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$15.00 | $45.00 | Q:25 /31Days | $1,241.56 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$0.00 |
$320 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,235.91 |
Browse Plan Formulary |
Universal Hassle-Free (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $220.00 | None | $1,235.12 |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,241.96 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,239.89 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,242.19 |
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 EXTRA (HMO SNP)
|
$10.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:25 /31Days | $1,234.41 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$18.10 |
$320 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:11 /31Days | $1,241.97 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO SNP)
|
$18.20 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:14 /30Days | $1,221.43 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$19.20 |
$320 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:11 /31Days | $1,242.07 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-161 (HMO SNP)
|
$20.00 |
$320 |
to be determined |
4 |
Tier 4 |
$87.00 | $251.00 | Q:14 /30Days | $1,221.43 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$23.20 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:14 /30Days | $1,221.41 |
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)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:14 /30Days | $1,221.65 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
25% | n/a | Q:25 /31Days | $1,241.56 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
25% | n/a | Q:25 /31Days | $1,241.56 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $75.00 | Q:25 /31Days | $1,241.56 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $200.00 | None | $1,235.12 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | Q:14 /30Days | $1,224.95 |
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 |
Aetna Medicare Value Plan (HMO)
|
$38.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,227.06 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$68.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,230.21 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$99.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | Q:14 /30Days | $1,225.48 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$150.00 |
$105 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:24 /90Days | $1,219.78 |
Browse Plan Formulary |