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Please note:  The plan’s average retail drug price (30-day supply) shown below is from the April 2012 dataset. Your actual retail drug price may differ significantly from the average shown. Please contact the Medicare plan or Medicare (1-800-Medicare) for more specific pricing based on your chosen pharmacy.

There are 6 California 2012 stand-alone Medicare Part D plans meeting your criteria.

Caution: The 2012 Medicare Part D plan information below is for research purposes.
Click here to see 2020 Medicare Part D plans

Ortho Cept 6 DIALPACK in 1 CARTON / 1 KIT in 1 DIALPACK (6 DIALPACK in 1 CARTON / ) (NDC: 50458019615)
2012 Medicare Part D Plan Information
Click here to jump to 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
Humana Enhanced (PDP)
 
$43.20 $0 No additional gap coverage, only the Donut Hole Discount 3 Non-Preferred Brand Drugs $74.00$212.00None$52.18
Browse Plan Formulary
AARP MedicareRx Preferred (PDP)
 
$48.20 $0 No additional gap coverage, only the Donut Hole Discount 4 Non-Preferred Brand Drugs $94.00$267.00None$51.95
Browse Plan Formulary
Health Net Orange Option 2 (PDP)
 
$87.60 $0 No additional gap coverage, only the Donut Hole Discount 3 Non-Preferred Brand Drugs $75.00$188.00None$51.40
Browse Plan Formulary
AARP MedicareRx Enhanced (PDP)
 
$96.10 $0 Some Generics 4 Non-Preferred Brand Drugs $76.00$213.00None$51.95
Browse Plan Formulary
Blue Cross MedicareRx Gold (PDP)
 
$107.30 $0 Many Generics,
Some Brands
4 Non-Preferred Brand Drugs $90.00$225.00None$54.02
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 Complete (PDP)
 
$114.90 $0 Many Generics,
Some Brands
3 Non-Preferred Brand Drugs $69.00$197.00None$52.18
Browse Plan Formulary

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Chart Legend:

What does all this mean? Below are a few notes to help you understand the above 2012 Medicare Part D Plan Formulary.

  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $320 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.
    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.

  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2930) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2015 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).

  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.


  • Plan’s Avg. Retail Drug Price: This is the Medicare Part D prescription drug plan’s average negotiated retail drug price. This price is calculated for each plan by averaging the negotiated retail price for a particular drug across all pharmacies in the plan’s service area. For example. The negotiated retail drug price for Quetiapine Fumarate 25MG Tables on the AARP MedicareRx Saver Plus plan in Florida (S5921-356) is determined by averaging all of the AARP MedicareRx Saver Plus plan’s negotiated retail drug prices for a Florida pharmacies.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2012 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.