SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR (1 50 MG SINGLE DOSE SYR SYR) (NDC: 57894007001)
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 | 5 |
Tier 5 |
33% | 33% | P | $2,154.96 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,154.96 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,134.57 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,134.57 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $2,240.04 |
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 |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $2,232.30 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $2,232.30 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:1 /28Days | $2,185.45 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:1 /28Days | $2,185.45 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
30% | 30% | P | $2,183.45 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
30% | 30% | P | $2,183.45 |
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 |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
30% | 30% | P | $2,183.45 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
30% | 30% | P | $2,183.45 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$320 | to be determined | 5 |
Tier 5 |
25% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$320 | to be determined | 5 |
Tier 5 |
25% | n/a | P | $2,368.22 |
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 |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
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 |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,193.87 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,193.87 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,193.87 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,193.87 |
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 |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P Q:1 /28Days | $2,185.57 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P Q:1 /28Days | $2,185.57 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.89 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.89 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.89 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.89 |
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 B Only South (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $2,347.15 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $2,347.15 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $2,377.54 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $2,377.54 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.89 |
Browse Plan Formulary |
Salud con Health Net Medicare Advantage (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.89 |
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 |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,368.22 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$8.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $2,347.15 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$8.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $2,347.15 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$20.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.92 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$20.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,131.92 |
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 TotalDual Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $2,183.45 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $2,183.45 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | 25% | P Q:1 /28Days | $2,183.45 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$30.80 |
$320 | to be determined | 5 |
Tier 5 |
25% | 25% | P Q:1 /28Days | $2,183.45 |
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:1 /28Days | $2,223.30 |
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:1 /28Days | $2,223.30 |
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:1 /28Days | $2,185.45 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:1 /28Days | $2,185.45 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:1 /28Days | $2,185.45 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$30.90 |
$320 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:1 /28Days | $2,185.45 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$30.90 |
$320 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $2,193.87 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$30.90 |
$320 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $2,193.87 |
Browse Plan Formulary |