AMINOSYN HBC INJECTION SULFITE FREE 7% (12 X 500 ML BAG) (NDC: 00409416803)
2013 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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $780.71 |
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 |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$33.00 | $66.00 | P | $773.78 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
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 |
HumanaChoice R5826-072 (Regional PPO)
|
$20.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P | $767.55 |
Browse Plan Formulary |
HealthPlus MedicarePlus-Advantage D-SNP (HMO SNP)
|
$23.60 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | P | $773.78 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$32.70 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $785.88 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
|
$34.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | None | $603.56 |
Browse Plan Formulary |
CareSource Advantage (HMO SNP)
|
$34.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $805.90 |
Browse Plan Formulary |
Total Medicare Plus (HMO SNP)
|
$34.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | n/a | P | $772.63 |
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 |
UnitedHealthcare Dual Complete (HMO SNP)
|
$34.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
n/a | n/a | P | $772.20 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$37.50 |
$0 |
Few Generics, Few Brands |
3 |
Non-Preferred Brand |
$80.00 | $230.00 | P | $767.55 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $791.29 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$54.00 |
$50 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $791.29 |
Browse Plan Formulary |
BCN Advantage HMO Focus (HMO)
|
$58.00 |
$50 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $780.71 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 1 (HMO-POS)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$39.00 | $78.00 | P | $773.78 |
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 Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $780.71 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$94.00 |
$25 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $791.29 |
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 |
Alliance Medicare PPO (PPO)
|
$103.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $791.28 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $780.71 |
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 |
HAP Senior Plus - Henry Ford (HMO)
|
$122.00 |
$50 |
All Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $791.29 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS)
|
$125.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$35.00 | $70.00 | P | $773.78 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantagePPO Enhanced (PPO)
|
$136.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$35.00 | $70.00 | P | $773.78 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$169.00 |
$25 |
All Generics |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $791.29 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$174.00 |
$50 |
All Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $791.28 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $780.71 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $780.71 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $780.71 |
Browse Plan Formulary |