NEUPOGEN 300MCG/ML VIAL (10 X 1.6 ML VIALSD) (NDC: 55513054610)
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 | $4,252.59 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,290.67 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,290.67 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,273.91 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:67 /90Days | $4,240.97 |
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 | P | $4,240.84 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,236.08 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,240.88 |
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 |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,240.88 |
Browse Plan Formulary |
Coventry Summit Select (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,240.88 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,240.88 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,240.88 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,263.02 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,263.36 |
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 |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,253.90 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,253.90 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $4,208.61 |
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:14 /30Days | $4,238.65 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (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 |
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% | Q:67 /90Days | $4,240.97 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:67 /90Days | $4,240.97 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:67 /90Days | $4,240.97 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:67 /90Days | $4,240.97 |
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% | Q:67 /90Days | $4,240.97 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,201.98 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,252.73 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,252.73 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$320 |
to be determined |
2 |
Tier 2 |
25% | n/a | P | n/a |
Browse Plan Formulary |
Preferred Choice Broward (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,241.11 |
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 Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,241.11 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,241.11 |
Browse Plan Formulary |
Preferred Select Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,241.11 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,290.67 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,268.73 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | None | $4,363.48 |
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 |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$0.00 |
$320 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $4,254.33 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,255.11 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,274.88 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$1.10 |
$320 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,201.98 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$6.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,240.88 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$18.10 |
$320 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,292.25 |
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 Access (HMO SNP)
|
$19.20 |
$320 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,292.68 |
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 | $4,240.88 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
|
$21.60 |
$320 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$22.90 |
$320 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$23.80 |
$320 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $4,201.47 |
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 | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.80 |
$320 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
Coventry Vista Maximum (HMO SNP)
|
$23.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,240.88 |
Browse Plan Formulary |
MediMax (HMO)
|
$23.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $4,364.75 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:67 /90Days | $4,240.97 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:14 /30Days | $4,238.65 |
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 H5415-056 (PPO)
|
$39.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,206.18 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$68.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,280.12 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$99.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,262.73 |
Browse Plan Formulary |
HumanaChoice H5415-068 (PPO)
|
$149.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,208.61 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$150.00 |
$105 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,175.16 |
Browse Plan Formulary |