CEFOXITIN FOR INJECTION SOLUTION (NDC: 60505076104)
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 Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $908.80 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $876.83 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $876.83 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | None | $930.19 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$4.00 | $8.00 | None | $842.94 |
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 |
BlueMedicare HMO (HMO)
|
$0.00 |
$0 |
All Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $777.05 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $15.00 | None | $711.66 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $705.99 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
$40.00 | $120.00 | P | $844.13 |
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 |
Coventry Summit Ideal (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$65.00 | $195.00 | None | $932.70 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$70.00 | $210.00 | None | $938.43 |
Browse Plan Formulary |
Coventry Summit Select (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$70.00 | $210.00 | None | $938.50 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$50.00 | $150.00 | None | $938.50 |
Browse Plan Formulary |
Humana Gold Plus H1036-062C (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
Humana Gold Plus H1036-199 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $705.99 |
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 SNP-CVD/CHF H1036-190 (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-130C (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $705.99 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$45.00 | $115.00 | None | $911.27 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $270.00 | None | $911.27 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
$40.00 | $120.00 | P | $844.13 |
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 |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $902.42 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$0.00 | $0.00 | None | $900.01 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | None | $908.80 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | P | $844.13 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $917.83 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$8.70 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $917.83 |
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 Access (HMO SNP)
|
$12.10 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $917.83 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-104A (HMO SNP)
|
$16.50 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $842.96 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-152 (HMO SNP)
|
$22.30 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$23.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $908.80 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 |
to be determined |
4 |
Tier 4 |
$95.00 | $95.00 | None | $864.58 |
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 Specialty + Rx (HMO SNP)
|
$24.70 |
$325 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $842.94 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$24.80 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$24.80 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $705.99 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $908.80 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | None | $938.50 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | None | $705.99 |
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)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | None | $930.98 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 |
Few Generics, Few Brands |
3 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $705.99 |
Browse Plan Formulary |
Day Break (HMO)
|
$68.00 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
$60.00 | $180.00 | P | $844.13 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $705.99 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$17.00 | $24.00 | None | $711.66 |
Browse Plan Formulary |
HumanaChoice H5415-067 (PPO)
|
$152.00 |
$0 |
Few Generics, Few Brands |
3 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $705.99 |
Browse Plan Formulary |