Zemplar 2ug/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 1 mL in 1 VIAL, SINGLE-DOSE (25 VIAL, SINGLE-DOSE in 1 ) (NDC: 00074463701)
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 | P | $625.75 |
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 | P | $638.33 |
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 | P | $638.33 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | P | $649.01 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $160.00 | P | $622.08 |
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 |
BlueMedicare HMO (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Preferred Brand |
$45.00 | $135.00 | P | $634.74 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | P | $621.24 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | P | $634.70 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | P | $634.70 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | P | $634.70 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$40.00 | $120.00 | P | $641.94 |
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 |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$20.00 | $40.00 | P | $626.30 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$25.00 | $50.00 | P | $626.30 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$5.00 | $10.00 | P | $626.30 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$5.00 | $10.00 | P | $626.30 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$20.00 | $40.00 | P | $626.30 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$20.00 | $40.00 | P | $626.30 |
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 |
Humana Gold Plus H1036-062C (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | P | $634.70 |
Browse Plan Formulary |
Humana Gold Plus H1036-199 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | P | $634.70 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-190 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | P | $634.70 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-130C (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | P | $634.70 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | P | $610.38 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $90.00 | P | $641.45 |
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 |
PUP EASY (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$5.00 | $10.00 | P | $626.59 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$15.00 | $25.00 | P | $624.66 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$40.00 | $120.00 | P | $641.94 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 | to be determined | 2 |
Tier 2 |
$0.00 | $0.00 | P | $625.75 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | P | $641.94 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-104A (HMO SNP)
|
$16.50 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | P | $634.70 |
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 |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | $619.20 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-152 (HMO SNP)
|
$22.30 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | P | $634.70 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$23.10 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | P | $626.30 |
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% | P | $627.81 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 | Some Generics | 4 |
Non-Preferred Brand |
25% | 25% | P | $622.08 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | P | $626.30 |
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 |
CareNeeds (HMO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | P | $634.70 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | P | $634.70 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | P | $626.30 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | P | $626.30 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | P | $625.75 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $110.00 | P | $610.38 |
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 | 3 |
Preferred Brand |
$45.00 | $90.00 | P | $649.01 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 | Few Generics, Few Brands | 2 |
Preferred Brand |
$43.00 | $119.00 | P | $610.38 |
Browse Plan Formulary |
Day Break (HMO)
|
$68.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$60.00 | $180.00 | P | $641.94 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | P | $610.38 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | P | $619.29 |
Browse Plan Formulary |
HumanaChoice H5415-067 (PPO)
|
$152.00 |
$0 | Few Generics, Few Brands | 2 |
Preferred Brand |
$40.00 | $110.00 | P | $634.70 |
Browse Plan Formulary |