PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY (24 X 1 ML TRAY) (NDC: 59676032004)
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 |
5 |
Specialty Tier |
33% | 33% | P | $1,594.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
Some Generics |
5 |
Specialty Tier |
33% | 33% | P | $1,599.43 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $1,599.43 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $1,626.08 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $1,594.08 |
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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:12 /30Days | $1,625.87 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$0.00 |
$0 |
All Generics |
5 |
Specialty Tier |
33% | 33% | P | $1,604.33 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $1,605.58 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
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 |
CareOne (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | 33% | P | $1,635.00 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$40.00 | $120.00 | P Q:12 /28Days | $1,653.68 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$70.00 | $210.00 | P Q:12 /28Days | $1,661.06 |
Browse Plan Formulary |
Coventry Summit Select (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$70.00 | $210.00 | P Q:12 /28Days | $1,655.09 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$75.00 | $225.00 | P Q:12 /28Days | $1,645.23 |
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 Vista Prime (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$50.00 | $150.00 | P Q:12 /28Days | $1,649.39 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,597.50 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | n/a | P | $1,670.60 |
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 |
Medica HealthCare Plans MedicareMax Value RX (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | P | $1,673.41 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
25% | n/a | P | $1,606.83 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,598.12 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,594.35 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | P Q:12 /30Days | $1,634.37 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P Q:12 /30Days | $1,634.37 |
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 |
Simply More (HMO)
|
$0.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P Q:12 /30Days | $1,634.37 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P Q:12 /30Days | $1,634.37 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
5 |
Specialty Tier |
25% | n/a | P Q:12 /28Days | $1,684.82 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
5 |
Specialty Tier |
25% | n/a | P Q:12 /28Days | $1,684.82 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | 33% | P | $1,635.00 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | n/a | P | $1,640.07 |
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 Essential (HMO)
|
$0.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | n/a | P | $1,649.04 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | P | $1,655.84 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:12 /28Days | $1,594.52 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 |
to be determined |
4 |
Tier 4 |
15% | 15% | P | $1,635.00 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $1,643.69 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$8.70 |
$325 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $1,646.34 |
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 |
4 |
Tier 4 |
25% | n/a | P | $1,646.34 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$12.20 |
$325 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | P Q:12 /28Days | $1,653.95 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $1,578.61 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-185 (HMO SNP)
|
$20.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
|
$20.60 |
$325 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $1,615.82 |
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 |
CareNeeds PLUS (HMO SNP)
|
$23.20 |
$325 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO SNP)
|
$23.40 |
$325 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $1,673.41 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$23.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P | $1,595.81 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 |
to be determined |
3 |
Tier 3 |
$95.00 | $95.00 | P | $1,598.93 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 |
Some Generics |
5 |
Specialty Tier |
25% | 25% | P | $1,594.08 |
Browse Plan Formulary |
Coventry Vista Maximum (HMO SNP)
|
$24.70 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | P Q:12 /28Days | $1,653.95 |
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 |
MediMax (HMO)
|
$24.70 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
25% | n/a | P Q:12 /28Days | $1,671.25 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$24.80 |
$325 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$24.80 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P Q:12 /30Days | $1,634.37 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$24.80 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P Q:12 /30Days | $1,634.37 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$24.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:12 /30Days | $1,634.37 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 |
to be determined |
5 |
Tier 5 |
15% | 15% | P | $1,594.72 |
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 Vista Maximum Choice (HMO SNP)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | P Q:12 /28Days | $1,656.33 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,597.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $1,642.24 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 |
Few Generics, Few Brands |
4 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,591.25 |
Browse Plan Formulary |
Day Break (HMO)
|
$68.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | 33% | P | $1,635.00 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,596.01 |
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 PPO (PPO)
|
$152.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | P | $1,607.38 |
Browse Plan Formulary |
HumanaChoice H5415-068 (PPO)
|
$152.00 |
$0 |
Few Generics, Few Brands |
4 |
Specialty Tier |
33% | n/a | P Q:14 /30Days | $1,615.82 |
Browse Plan Formulary |