BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM (14 TRAY BOX PKGCOM) (NDC: 50419052335)
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 Mosaic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $4,418.14 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $4,418.14 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $4,418.14 |
Browse Plan Formulary |
Access Medicare Gold (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
30% | 30% | S | $4,514.73 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
Some Generics |
5 |
Specialty Tier |
33% | 33% | P Q:14 /28Days | $4,429.69 |
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 |
Amerivantage Classic Choice + Rx Plan (HMO-POS)
|
$0.00 |
$0 |
Some Generics |
5 |
Specialty Tier |
25% | 25% | P Q:14 /28Days | $4,429.69 |
Browse Plan Formulary |
Easy Choice Diamond Rewards (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P | $4,460.24 |
Browse Plan Formulary |
Easy Choice Diamond Rewards COPD (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P | $4,460.24 |
Browse Plan Formulary |
Easy Choice Rewards (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P | $4,460.24 |
Browse Plan Formulary |
Easy Choice Value (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $4,460.24 |
Browse Plan Formulary |
Elderplan Classic: Zero Premium (HMO)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
25% | 25% | P | $4,588.85 |
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 |
Empire MediBlue Plus (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Specialty Tier |
33% | n/a | P | $4,677.30 |
Browse Plan Formulary |
Fidelis Medicare $0 Premium (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P Q:14 /28Days | $4,420.60 |
Browse Plan Formulary |
Healthfirst 65 Plus Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P Q:14 /28Days | $4,401.01 |
Browse Plan Formulary |
Healthfirst Jade Benefits Plan (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
4 |
Specialty Tier |
33% | 33% | P Q:14 /28Days | $4,401.01 |
Browse Plan Formulary |
Liberty Health Advantage Preferred Choice (HMO)
|
$0.00 |
$0 |
All Generics |
5 |
Specialty Tier |
25% | n/a | P Q:15 /30Days | $4,552.91 |
Browse Plan Formulary |
Touchstone Health Medicare Freedom (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P Q:15 /30Days | $4,552.91 |
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 |
Touchstone Health Medicare Power (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P Q:15 /30Days | $4,552.91 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $4,427.20 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Enhanced (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | 25% | P Q:14 /28Days | $4,401.10 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
|
$34.70 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P Q:14 /28Days | $4,402.81 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$35.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P Q:14 /28Days | $4,401.01 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$35.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P | $4,429.98 |
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 |
Touchstone Health Medicare Total (HMO)
|
$38.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P Q:15 /30Days | $4,552.91 |
Browse Plan Formulary |
HHH Choices Gold (HMO SNP)
|
$39.70 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $4,569.56 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
|
$40.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:14 /28Days | $4,401.10 |
Browse Plan Formulary |
Elderplan Advantage For Nursing Home Residents (HMO SNP)
|
$40.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $4,588.85 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$41.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
n/a | n/a | P | $4,428.77 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO SNP)
|
$41.70 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | P Q:14 /28Days | $4,402.81 |
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 |
UnitedHealthcare Dual Complete LP (HMO SNP)
|
$42.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $4,418.14 |
Browse Plan Formulary |
Healthfirst AssuredCare (HMO SNP)
|
$43.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P Q:14 /28Days | $4,401.01 |
Browse Plan Formulary |
Healthfirst CompleteCare (HMO SNP)
|
$43.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
n/a | n/a | P Q:14 /28Days | $4,401.01 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO SNP)
|
$43.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P Q:14 /28Days | $4,401.02 |
Browse Plan Formulary |
Healthfirst Maximum Plan (HMO SNP)
|
$43.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
n/a | n/a | P Q:14 /28Days | $4,401.02 |
Browse Plan Formulary |
MetroPlus Select Plan (HMO SNP)
|
$43.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | P Q:14 /28Days | $4,402.81 |
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 |
Access Medicare Pearl (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | S | $4,514.73 |
Browse Plan Formulary |
Access Medicare Platinum (HMO)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $4,514.73 |
Browse Plan Formulary |
Access Medicare Silver (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $4,514.73 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | P Q:14 /28Days | $4,418.06 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Brand |
25% | 25% | P Q:14 /28Days | $4,418.06 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$43.20 |
$325 |
Many Generics, Few Brands |
5 |
Specialty Tier |
25% | 25% | P Q:14 /28Days | $4,429.69 |
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 |
ArchCare - Inst and IE SNP - All Counties (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P Q:14 /28Days | $4,429.37 |
Browse Plan Formulary |
CenterLight Direct Complete Plan (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
25% | 25% | P Q:45 /90Days | $4,536.04 |
Browse Plan Formulary |
CenterLight Direct Total Plan (HMO SNP)
|
$43.20 |
$185 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
28% | 28% | P Q:45 /90Days | $4,536.04 |
Browse Plan Formulary |
Elderplan Extra Help (HMO)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $4,588.85 |
Browse Plan Formulary |
Elderplan For Medicaid Beneficiaries (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $4,588.85 |
Browse Plan Formulary |
Elderplan Medicaid Advantage (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $4,588.85 |
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 |
Elderplan Plus Long Term Care (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $4,588.85 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | 25% | P Q:14 /28Days | $4,420.60 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
|
$43.20 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | 25% | P Q:14 /28Days | $4,429.46 |
Browse Plan Formulary |
Fidelis Long Term Care Advantage (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:14 /28Days | $4,429.46 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | 25% | P Q:14 /28Days | $4,418.05 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex (HMO-POS)
|
$43.20 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | 25% | P Q:14 /28Days | $4,429.46 |
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 |
Liberty Health Advantage Dual Power (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:15 /30Days | $4,847.88 |
Browse Plan Formulary |
Senior Whole Health of New York (HMO SNP)
|
$43.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Brand |
$45.00 | $135.00 | Q:18 /30Days | $4,627.37 |
Browse Plan Formulary |
MetroPlus Medicare Partnership in Care Plan (HMO SNP)
|
$67.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | P Q:14 /28Days | $4,402.81 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Maximum (HMO SNP)
|
$78.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
n/a | n/a | P Q:14 /28Days | $4,401.10 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
|
$95.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
n/a | n/a | P Q:14 /28Days | $4,401.10 |
Browse Plan Formulary |