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 |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $772.20 |
Browse Plan Formulary |
Advantra (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$70.00 | $210.00 | P | $773.87 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $801.99 |
Browse Plan Formulary |
Amerivantage Classic+ Rx (HMO)
|
$0.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $799.66 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $783.56 |
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 |
Care Improvement Plus Copper RX (Regional PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $783.56 |
Browse Plan Formulary |
HealthSpring Achieve (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$70.00 | $200.00 | P | $772.33 |
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 |
HealthSpring Preferred (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$60.00 | $170.00 | P | $772.33 |
Browse Plan Formulary |
Humana Gold Plus H4510-028 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | P | $767.55 |
Browse Plan Formulary |
KelseyCare Advantage Rx (HMO)
|
$0.00 |
$50 |
Many Generics |
3 |
Preferred Brand |
$40.00 | n/a | P | $773.24 |
Browse Plan Formulary |
TexanPlus Classic (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $796.91 |
Browse Plan Formulary |
TexanPlus Select (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $796.91 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$30.00 | $60.00 | None | $789.11 |
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 Value (HMO-POS)
|
$0.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$30.00 | $60.00 | None | $789.11 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$18.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $90.00 | None | $789.11 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$29.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$89.00 | $257.00 | P | $767.55 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P | $772.20 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.90 |
$325 |
Many Generics, Few Brands |
3 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $785.88 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$31.80 |
$325 |
Many Generics, Few Brands |
4 |
Non-Preferred Brand |
25% | 25% | P | $799.66 |
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 |
Care Improvement Plus Chrome RX (PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (Regional PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $783.56 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $783.56 |
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 |
HealthSpring TotalCare (HMO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $772.33 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $796.91 |
Browse Plan Formulary |
Erickson Advantage Freedom (HMO-POS)
|
$48.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | P | $772.20 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $801.99 |
Browse Plan Formulary |
Humana Prime Choice H4520-006 (PPO)
|
$57.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$83.00 | $239.00 | P | $767.55 |
Browse Plan Formulary |
Today''s Options Premier Plus 650B (PFFS)
|
$66.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $796.91 |
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 |
KelseyCare Advantage Rx + Choice (HMO-POS)
|
$77.00 |
$50 |
Many Generics |
3 |
Preferred Brand |
$40.00 | n/a | P | $773.24 |
Browse Plan Formulary |
Humana Gold Choice H8145-084 (PFFS)
|
$87.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | P | $767.55 |
Browse Plan Formulary |
Today''s Options Advantage Plus 350A (PPO)
|
$107.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $796.91 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$122.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $796.91 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$176.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | P | $772.20 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$176.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | P | $772.20 |
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 |
KelseyCare Advantage Rx Premier (HMO)
|
$213.00 |
$50 |
Many Generics |
3 |
Preferred Brand |
$20.00 | n/a | P | $773.24 |
Browse Plan Formulary |