ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD (4 X 40MCG/ 1ML VIALSD) (NDC: 55513000304)
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 SecureHorizons (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,083.26 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,059.81 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 4 |
Non-Preferred Brand |
$92.00 | $266.00 | P | $1,059.81 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$45.00 | $90.00 | P | $1,094.44 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Injectable Drugs |
33% | 33% | P | $1,117.80 |
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 II (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Injectable Drugs |
33% | 33% | P | $1,117.80 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Injectable Drugs |
25% | 25% | P | $1,046.04 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Injectable Drugs |
25% | 25% | P | $1,046.04 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Brand |
$40.00 | $80.00 | P Q:4 /28Days | $1,101.48 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$30.00 | $60.00 | P | $1,085.81 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$30.00 | $60.00 | P | $1,085.81 |
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 Breathe (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:4 /28Days | $1,151.39 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$325 | All Generics, Few Brands | 4 |
Non-Preferred Brand |
25% | 25% | P Q:4 /28Days | $1,145.00 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:4 /28Days | $1,151.39 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:4 /28Days | $1,151.39 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:4 /28Days | $1,151.39 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:4 /28Days | $1,151.39 |
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 Value Plus (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:4 /28Days | $1,088.84 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$50.00 | $100.00 | P Q:4 /28Days | $1,088.84 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
25% | 25% | P Q:4 /28Days | $1,088.84 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Injectable Drugs |
25% | 25% | P Q:5 /30Days | $1,129.33 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $80.00 | P Q:4 /28Days | $1,099.52 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $80.00 | P Q:4 /28Days | $1,102.03 |
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 | Many Generics | 3 |
Preferred Brand |
$40.00 | $80.00 | P Q:4 /28Days | $1,102.03 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,056.03 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,056.03 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,056.03 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,056.03 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$65.00 | $130.00 | P | $1,130.13 |
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 LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 4 |
Non-Preferred Brand |
$60.00 | $120.00 | P | $1,122.49 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:4 /28Days | $1,151.39 |
Browse Plan Formulary |
UnitedHealthcare MedicareDirect Rx (PFFS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,073.33 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $1,130.13 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$23.90 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $1,056.03 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | P | $1,059.81 |
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 |
Anthem Medicare Preferred Standard (PPO)
|
$28.00 |
$90* | No additional gap coverage, only the Donut Hole Discount | 5* |
Injectable Drugs |
33% | 33% | P | $1,117.80 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:4 /28Days | $1,101.48 |
Browse Plan Formulary |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | P Q:4 /28Days | $1,101.48 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:4 /28Days | $1,101.48 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325 | Few Generics | 3 |
Preferred Brand |
25% | 25% | P | $1,085.81 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | P | $1,056.03 |
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 |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | P | $1,055.99 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $135.00 | P | $1,051.97 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
25% | 25% | P Q:4 /28Days | $1,088.84 |
Browse Plan Formulary |
Freedom Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
25% | 25% | P Q:4 /28Days | $1,101.17 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | P Q:4 /28Days | $1,101.17 |
Browse Plan Formulary |
Today''s Options Premier Plus 650H (PFFS)
|
$87.00 |
$87 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | P | $1,060.77 |
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 |
Today''s Options Premier Plus 350A (PFFS)
|
$144.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $80.00 | P | $1,060.77 |
Browse Plan Formulary |