AVONEX ADMIN PACK 30MCG SYR (1 X 4 PKGCOM) (NDC: 59627000205)
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 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $17,323.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $17,548.70 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | None | $17,594.70 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | None | $17,595.70 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | None | $17,594.70 |
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 Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | None | $17,595.70 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | None | $17,594.70 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | None | $17,595.70 |
Browse Plan Formulary |
Care N'' Care Health Plan III (PPO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P Q:2 /28Days | $17,925.50 |
Browse Plan Formulary |
HealthSpring Achieve (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $17,454.00 |
Browse Plan Formulary |
HealthSpring Preferred (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $17,460.40 |
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 H4510-018 (HMO)
|
$0.00 |
$125 | Few Generics, Few Brands | 5 |
Specialty Tier |
30% | n/a | P Q:4 /28Days | $17,400.90 |
Browse Plan Formulary |
TexanPlus Classic (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $17,340.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$22.60 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P | $17,323.10 |
Browse Plan Formulary |
Care N'' Care Health Plan II (PPO)
|
$29.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P Q:2 /28Days | $17,925.50 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$29.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | n/a | P Q:4 /28Days | $17,395.90 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$29.10 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $17,324.20 |
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 |
Advantage by Superior HealthPlan (HMO SNP)
|
$30.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Injectable Drugs |
$95.00 | $95.00 | None | $17,436.00 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.90 |
$325 | Many Generics, Few Brands | 4 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $17,163.30 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-023 (HMO SNP)
|
$31.70 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | P Q:4 /28Days | $17,401.20 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $17,594.70 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (Regional PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $17,595.70 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | None | $17,594.70 |
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 Dual Advantage (Regional PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | None | $17,595.70 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $17,594.70 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $17,595.70 |
Browse Plan Formulary |
HealthSpring TotalCare (HMO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | P Q:4 /28Days | $17,460.40 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
29% | n/a | P Q:4 /28Days | $17,330.70 |
Browse Plan Formulary |
HealthSpring Preferred (PPO)
|
$35.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $17,484.30 |
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 |
Erickson Advantage Freedom (HMO-POS)
|
$48.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P | $17,433.40 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$56.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $17,548.70 |
Browse Plan Formulary |
Humana Prime Choice H4520-006 (PPO)
|
$57.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $17,383.20 |
Browse Plan Formulary |
Today''s Options Premier Plus 650B (PFFS)
|
$66.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
29% | n/a | P Q:4 /28Days | $17,313.50 |
Browse Plan Formulary |
Blue Medicare Advantage (PPO)
|
$69.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $17,466.30 |
Browse Plan Formulary |
Care N'' Care Health Plan I (PPO)
|
$75.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P Q:2 /28Days | $17,925.50 |
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 Choice H8145-084 (PFFS)
|
$87.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $17,402.10 |
Browse Plan Formulary |
Today''s Options Advantage Plus 350A (PPO)
|
$107.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $17,330.70 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$122.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $17,313.50 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P | $17,433.40 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P | $17,433.40 |
Browse Plan Formulary |