PROCRIT 3000U/ML VIAL (25 X 1 ML VIALSD) (NDC: 59676030302)
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 | $1,324.23 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$92.00 | $266.00 | P | $1,324.23 |
Browse Plan Formulary |
Advantage I MAPD (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | P | $1,309.31 |
Browse Plan Formulary |
Advantage I MAPD (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | P | $1,309.31 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | P Q:12 /30Days | $1,352.79 |
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 |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | P Q:12 /30Days | $1,352.79 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,387.07 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,387.39 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,387.39 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:12 /28Days | $1,373.60 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:12 /28Days | $1,373.60 |
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 | $1,375.32 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $1,375.32 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $1,375.32 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $1,375.32 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
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 |
CareMore Connect (HMO SNP)
|
$0.00 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
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 |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,362.46 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $62.50 | P Q:12 /28Days | $1,362.46 |
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 Q:12 /28Days | $1,362.35 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$50.00 | $100.00 | P Q:12 /28Days | $1,362.35 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:12 /30Days | $1,309.31 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:12 /30Days | $1,309.31 |
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 | $1,373.96 |
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 | $1,373.96 |
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 | $1,311.47 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $1,311.47 |
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 | $1,311.47 |
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 | $1,311.47 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $150.00 | P | $1,383.41 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $150.00 | P | $1,383.41 |
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 |
Humana Gold Plus H0108-011 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | P Q:14 /30Days | $1,341.07 |
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 Q:12 /28Days | $1,363.67 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $210.00 | P Q:12 /28Days | $1,363.67 |
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 | $1,313.27 |
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 | $1,313.27 |
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 | $1,315.40 |
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 |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | n/a | P | $1,315.40 |
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 | $1,311.47 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $1,311.47 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $230.00 | P | $1,383.41 |
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 |
SCAN Classic (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $230.00 | P | $1,383.41 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $230.00 | P | $1,383.41 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $230.00 | P | $1,383.41 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $112.50 | P Q:12 /28Days | $1,427.47 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $112.50 | P Q:12 /28Days | $1,427.47 |
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 | $1,313.27 |
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 | $1,313.27 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$19.00 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $60.00 | P | $1,312.25 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $1,312.03 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | P | $1,312.03 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$25.80 |
$320 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $1,311.45 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$25.80 |
$320 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $1,311.45 |
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 |
Molina Medicare Options (HMO)
|
$29.00 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $60.00 | P | $1,312.25 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.10 |
$320 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $1,312.25 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.10 |
$320 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $1,312.25 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,375.32 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,375.32 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $1,375.32 |
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 | $1,375.32 |
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 | $1,379.84 |
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 | $1,379.84 |
Browse Plan Formulary |
Preferred Dual SNP (HMO SNP)
|
$30.80 |
$320* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $1,309.31 |
Browse Plan Formulary |
Preferred Dual SNP (HMO SNP)
|
$30.80 |
$320* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | P | $1,309.31 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,373.60 |
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 | $1,373.60 |
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 | $1,373.60 |
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 | $1,373.60 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$30.90 |
$320 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:12 /28Days | $1,363.42 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$30.90 |
$320 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:12 /28Days | $1,363.42 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $1,317.54 |
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 | $1,317.54 |
Browse Plan Formulary |
My Choice (HMO-POS)
|
$36.60 |
$0 | to be determined | 4 |
Tier 4 |
$65.00 | $185.00 | P | $1,383.41 |
Browse Plan Formulary |
Humana Gold Plus H0108-012 (HMO-POS)
|
$39.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | P Q:14 /30Days | $1,341.07 |
Browse Plan Formulary |
My Choice (HMO-POS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$65.00 | $185.00 | P | $1,383.41 |
Browse Plan Formulary |