PROCRIT 10000U/ML VIAL (6 X 1 ML VIALSD) (NDC: 59676031001)
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 SecureHorizons (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$92.00 | $266.00 | P | $2,118.06 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$92.00 | $266.00 | P | $2,118.06 |
Browse Plan Formulary |
Advantage I MAPD (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | P | $2,096.51 |
Browse Plan Formulary |
Advantage I MAPD (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | P | $2,096.51 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | P | $2,149.10 |
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 Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | P | $2,149.10 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,211.81 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,212.09 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,212.09 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:12 /28Days | $2,190.17 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:12 /28Days | $2,190.17 |
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 |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $2,196.24 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $2,196.24 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $2,196.24 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $2,196.24 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
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 |
CareMore Connect (HMO SNP)
|
$0.00 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,296.94 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,296.94 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
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 |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,296.94 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,170.98 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P | $2,170.98 |
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 |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$50.00 | $100.00 | P | $2,170.67 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$50.00 | $100.00 | P | $2,170.67 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,096.51 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,096.51 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P Q:12 /28Days | $2,189.94 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P Q:12 /28Days | $2,189.94 |
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 |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.72 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.72 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.72 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.72 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | P | $2,204.71 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | P | $2,204.71 |
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 H0108-011 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $230.00 | P Q:14 /30Days | $2,138.36 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$67.00 | $134.00 | P | $2,172.51 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $210.00 | P | $2,172.51 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | n/a | P | $2,113.12 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | n/a | P | $2,113.12 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | n/a | P | $2,123.44 |
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 |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | n/a | P | $2,123.44 |
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 |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$320 | to be determined | 2 |
Tier 2 |
25% | n/a | P | n/a |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.72 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.72 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,204.71 |
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 |
SCAN Classic (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,204.71 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,204.71 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,204.71 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $112.50 | P | $2,296.94 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $112.50 | P | $2,296.94 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$8.80 |
$0 | to be determined | 3 |
Tier 3 |
$43.00 | n/a | P | $2,113.12 |
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 |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$8.80 |
$0 | to be determined | 3 |
Tier 3 |
$43.00 | n/a | P | $2,113.12 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$19.00 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $60.00 | P | $2,099.98 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.77 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $2,099.77 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$25.80 |
$320 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $2,099.83 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$25.80 |
$320 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $2,099.83 |
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 |
Molina Medicare Options (HMO)
|
$29.00 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $60.00 | P | $2,099.98 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.10 |
$320 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $2,099.98 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.10 |
$320 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $2,099.98 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,196.24 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,196.24 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,195.75 |
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 |
Easy Choice Freedom Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,195.75 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$30.80 |
$320 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:12 /28Days | $2,211.26 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$30.80 |
$320 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:12 /28Days | $2,211.26 |
Browse Plan Formulary |
Preferred Dual SNP (HMO SNP)
|
$30.80 |
$320* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $2,096.51 |
Browse Plan Formulary |
Preferred Dual SNP (HMO SNP)
|
$30.80 |
$320* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $2,096.51 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $2,190.17 |
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 |
Brand New Day (HMO SNP)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $2,190.17 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $2,190.17 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $2,190.17 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$30.90 |
$320 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,173.01 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$30.90 |
$320 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,173.01 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $2,100.33 |
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 |
Health Net Seniority Plus Amber II (HMO SNP)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $2,100.33 |
Browse Plan Formulary |
My Choice (HMO-POS)
|
$36.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,204.71 |
Browse Plan Formulary |
Humana Gold Plus H0108-012 (HMO-POS)
|
$39.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $230.00 | P Q:14 /30Days | $2,138.36 |
Browse Plan Formulary |
My Choice (HMO-POS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,204.71 |
Browse Plan Formulary |