GLEEVEC 100MG TABLET (90 CT) (90 BOT) (NDC: 00078040134)
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 | $1,675.65 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,675.47 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,675.47 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:3 /1Days | $1,660.78 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,674.45 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,674.33 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:90 /30Days | $1,666.21 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:180 /30Days | $1,662.88 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:180 /30Days | $1,662.88 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:90 /30Days | $1,674.36 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:90 /30Days | $1,674.36 |
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 |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:90 /30Days | $1,674.36 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:240 /30Days | $1,680.58 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:240 /30Days | $1,681.40 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:240 /30Days | $1,681.40 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:240 /30Days | $1,681.40 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:240 /30Days | $1,681.40 |
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 |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,719.83 |
Browse Plan Formulary |
Healthy Advantage Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:90 /30Days | $1,842.99 |
Browse Plan Formulary |
Healthy Advantage Refund (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:90 /30Days | $1,842.99 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:180 /30Days | $1,662.88 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:180 /30Days | $1,662.88 |
Browse Plan Formulary |
Humana Reader's Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:180 /30Days | $1,664.22 |
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 |
JacksonHealth for Life (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,673.16 |
Browse Plan Formulary |
JacksonHealth Secure (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,673.16 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | P | $1,693.18 |
Browse Plan Formulary |
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 |
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 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,674.45 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,674.45 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,674.45 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,674.45 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,660.89 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:240 /30Days | $1,684.98 |
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 |
4 |
Tier 4 |
33% | 33% | P Q:240 /30Days | $1,684.98 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$320 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | n/a |
Browse Plan Formulary |
Preferred Choice Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:90 /30Days | $1,674.59 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:90 /30Days | $1,674.59 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | P Q:90 /30Days | $1,674.59 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:90 /30Days | $1,674.59 |
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 Premium Advantage Miami-Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:90 /30Days | $1,674.59 |
Browse Plan Formulary |
Preferred Special Care Miami-Dade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:90 /30Days | $1,674.59 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,675.47 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,676.08 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,719.79 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,719.79 |
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 |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,719.79 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | None | $1,719.83 |
Browse Plan Formulary |
WellCare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,679.99 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,679.99 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$1.10 |
$320 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,660.89 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$6.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:90 /30Days | $1,674.36 |
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)
|
$18.10 |
$320 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $1,689.62 |
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 |
Coventry Summit Maximum (HMO SNP)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:90 /30Days | $1,674.36 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$22.60 |
$320 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:180 /30Days | $1,662.88 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$23.80 |
$320 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $1,660.33 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$23.80 |
$320 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:180 /30Days | $1,662.88 |
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 |
5 |
Tier 5 |
25% | n/a | P Q:180 /30Days | $1,662.88 |
Browse Plan Formulary |
Coventry Vista Maximum (HMO SNP)
|
$23.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:90 /30Days | $1,674.36 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$23.80 |
$320 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:180 /30Days | $1,662.88 |
Browse Plan Formulary |
MediMax (HMO)
|
$23.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,715.16 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$23.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,719.79 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$23.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,719.79 |
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 |
Simply Complete (HMO SNP)
|
$23.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,719.79 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,679.99 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,674.45 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:180 /30Days | $1,664.22 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$39.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:180 /30Days | $1,663.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$68.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:3 /1Days | $1,666.87 |
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 | P Q:180 /30Days | $1,665.10 |
Browse Plan Formulary |