Aminosyn II Sulfite-Free 1490; 1527; 1050; 1107; 750; 450; 990; 1500; 1575; 258; 405; 447; 1083; 79 (6 BAG in 1 CASE / 2000 mL ) (NDC: 00409717117)
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 |
Advantra Elite (PPO)
![Email Prescription and/or Health Benefit details for Advantra Elite (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$88.00 | $264.00 | P | $255.47 |
Browse Plan Formulary |
Advantra Silver (HMO)
![Email Prescription and/or Health Benefit details for Advantra Silver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$85.00 | $255.00 | P | $255.47 |
Browse Plan Formulary |
Advantra Silver (PPO)
![Email Prescription and/or Health Benefit details for Advantra Silver (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$75.00 | $225.00 | P | $255.47 |
Browse Plan Formulary |
Bravo-HealthSpring Achieve (HMO SNP)
![Email Prescription and/or Health Benefit details for Bravo-HealthSpring Achieve (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | P | $244.93 |
Browse Plan Formulary |
Bravo-HealthSpring Classic (HMO)
![Email Prescription and/or Health Benefit details for Bravo-HealthSpring Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | P | $244.93 |
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 Blue PPO HD Rx (PPO)
![Email Prescription and/or Health Benefit details for Freedom Blue PPO HD Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $259.09 |
Browse Plan Formulary |
Gateway Health Plan Medicare Assured Select (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Plan Medicare Assured Select (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | None | $248.67 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | P | $254.40 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice (PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | P | $254.40 |
Browse Plan Formulary |
HumanaChoice H6900-004 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H6900-004 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $253.35 |
Browse Plan Formulary |
Today''s Options Advantage Plus 550B (PPO)
![Email Prescription and/or Health Benefit details for Today''s Options Advantage Plus 550B (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $262.91 |
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 |
HumanaChoice R5826-081 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-081 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P | $253.35 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
n/a | n/a | P | $254.40 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.70 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $253.35 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.70 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P | $254.40 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $266.19 |
Browse Plan Formulary |
AmeriHealth VIP Care (HMO SNP)
![Email Prescription and/or Health Benefit details for AmeriHealth VIP Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | P | $247.52 |
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 |
Gateway Health Plan Medicare Assured 3 (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Plan Medicare Assured 3 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | None | $251.05 |
Browse Plan Formulary |
Gateway Health Plan Medicare Assured (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Plan Medicare Assured (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $251.05 |
Browse Plan Formulary |
Bravo-HealthSpring Select (HMO SNP)
![Email Prescription and/or Health Benefit details for Bravo-HealthSpring Select (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.60 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $244.93 |
Browse Plan Formulary |
Geisinger Gold Secure 1 (HMO SNP)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 1 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $253.63 |
Browse Plan Formulary |
Advantra Cares (HMO SNP)
![Email Prescription and/or Health Benefit details for Advantra Cares (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | P | $255.47 |
Browse Plan Formulary |
Today''s Options Premier Plus 550B (PFFS)
![Email Prescription and/or Health Benefit details for Today''s Options Premier Plus 550B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $262.91 |
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 |
Geisinger Gold Classic 3 $0 Deductible Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 $0 Deductible Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$0 |
Few Generics |
4 |
Non-Preferred Brand |
$69.00 | $207.00 | P | $253.63 |
Browse Plan Formulary |
Advantra Silver Plus (PPO)
![Email Prescription and/or Health Benefit details for Advantra Silver Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P | $255.47 |
Browse Plan Formulary |
Gateway Health Plan Medicare Assured Select Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Plan Medicare Assured Select Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | None | $248.67 |
Browse Plan Formulary |
Geisinger Gold Preferred 2 $0 Deductible Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred 2 $0 Deductible Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.00 |
$0 |
Few Generics |
4 |
Non-Preferred Brand |
$69.00 | $207.00 | P | $253.63 |
Browse Plan Formulary |
Humana Gold Choice H8145-052 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-052 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $253.35 |
Browse Plan Formulary |
Freedom Blue PPO ValueRx (PPO)
![Email Prescription and/or Health Benefit details for Freedom Blue PPO ValueRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$95.00 | $237.50 | P | $259.09 |
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 |
SeniorBlue - Option 2 (PPO)
![Email Prescription and/or Health Benefit details for SeniorBlue - Option 2 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.70 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$44.00 | $132.00 | P | $259.08 |
Browse Plan Formulary |
Geisinger Gold Preferred 1 $0 Deductible Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred 1 $0 Deductible Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$74.00 |
$0 |
Few Generics |
4 |
Non-Preferred Brand |
$69.00 | $207.00 | P | $253.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
![Email Prescription and/or Health Benefit details for Advantra Gold (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$93.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$85.00 | $255.00 | P | $255.47 |
Browse Plan Formulary |
Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$100.00 |
$0 |
Few Generics |
4 |
Non-Preferred Brand |
$69.00 | $207.00 | P | $253.63 |
Browse Plan Formulary |
Today''s Options Advantage Plus 150A (PPO)
![Email Prescription and/or Health Benefit details for Today''s Options Advantage Plus 150A (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $262.91 |
Browse Plan Formulary |
Today''s Options Premier Plus 150A (PFFS)
![Email Prescription and/or Health Benefit details for Today''s Options Premier Plus 150A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $262.91 |
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 |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $266.19 |
Browse Plan Formulary |
Geisinger Gold Secure 3 (HMO SNP)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 3 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.00 |
$0 |
Few Generics |
4 |
Non-Preferred Brand |
$69.00 | $207.00 | P | $253.63 |
Browse Plan Formulary |
HumanaChoice H6900-005 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H6900-005 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$132.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $253.35 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$142.00 |
$0 |
Few Generics |
4 |
Non-Preferred Brand |
$69.00 | $207.00 | P | $253.63 |
Browse Plan Formulary |
Freedom Blue PPO Standard (PPO)
![Email Prescription and/or Health Benefit details for Freedom Blue PPO Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$165.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | P | $259.09 |
Browse Plan Formulary |
SeniorBlue - Option 1 (PPO)
![Email Prescription and/or Health Benefit details for SeniorBlue - Option 1 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$180.70 |
$0 |
Many Generics |
3 |
Preferred Brand |
$44.00 | $132.00 | P | $259.08 |
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 Blue PPO Deluxe (PPO)
![Email Prescription and/or Health Benefit details for Freedom Blue PPO Deluxe (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$208.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | P | $259.09 |
Browse Plan Formulary |