ARIXTRA 10MG SYRINGE (10 X .8 ML SYR) (NDC: 00007323611)
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% | None | $1,236.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,236.55 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,236.55 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,231.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $220.00 | None | $1,235.12 |
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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | Q:21 /60Days | $1,234.99 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:24 /90Days | $1,222.18 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | $110.00 | Q:14 /30Days | $1,224.23 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $65.00 | Q:14 /30Days | $1,224.23 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,243.74 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
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 Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,245.03 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | None | $1,248.23 |
Browse Plan Formulary |
Healthy Advantage Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:24 /30Days | $1,359.59 |
Browse Plan Formulary |
Healthy Advantage Refund (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:24 /30Days | $1,359.59 |
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 |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $65.00 | Q:14 /30Days | $1,224.23 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | $110.00 | Q:14 /30Days | $1,224.23 |
Browse Plan Formulary |
Humana Reader's Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | Q:14 /30Days | $1,224.95 |
Browse Plan Formulary |
JacksonHealth for Life (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $1,233.83 |
Browse Plan Formulary |
JacksonHealth Secure (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $1,233.83 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $1,251.09 |
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 (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 |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $150.00 | None | $1,235.12 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $1,235.12 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $1,235.12 |
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 |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $1,235.12 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,246.04 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,246.04 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$320 |
to be determined |
2 |
Tier 2 |
25% | n/a | P Q:24 /24Days | n/a |
Browse Plan Formulary |
Preferred Choice Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
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 |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
Browse Plan Formulary |
Preferred Premium Advantage Miami-Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
Browse Plan Formulary |
Preferred Special Care Miami-Dade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,235.26 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:25 /31Days | $1,236.55 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | Q:25 /31Days | $1,237.21 |
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 Extra (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | Q:25 /31Days | $1,248.50 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | Q:25 /31Days | $1,248.50 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$15.00 | $45.00 | Q:25 /31Days | $1,248.50 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | n/a | None | $1,248.23 |
Browse Plan Formulary |
WellCare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,242.35 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,242.35 |
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 | Q:11 /31Days | $1,241.97 |
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 |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$22.60 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:14 /30Days | $1,224.23 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$87.00 | $251.00 | Q:14 /30Days | $1,224.23 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$87.00 | $251.00 | Q:14 /30Days | $1,224.23 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:14 /30Days | $1,224.23 |
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 |
MediMax (HMO)
|
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | None | $1,263.56 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$10.00 | n/a | Q:25 /31Days | $1,248.50 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$10.00 | n/a | Q:25 /31Days | $1,248.50 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$10.00 | $30.00 | Q:25 /31Days | $1,248.50 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:11 /31Days | $1,242.35 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $200.00 | None | $1,235.12 |
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 |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | Q:14 /30Days | $1,224.95 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$39.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:14 /30Days | $1,226.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$68.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,230.21 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$99.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | Q:14 /30Days | $1,225.48 |
Browse Plan Formulary |