2013 Medicare Advantage Prescription Drug Price Information | ||||||
HumanaChoice R5826-079 (Regional PPO) (R5826-079-0) Benefit Details ![]() ![]() ![]() ![]() | ||||||
Click on a letter below to view the HumanaChoice R5826-079 (Regional PPO) Formulary A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||
TOPOTECAN HYDROCHLORIDE FOR INJECTION ![]() | ||||||
Plan’s average negotiated retail drug price in in Statewide, NC: CMS MA Region 7, includes: VA NC | $4,583.77* 30-Day Supply $9,704.46* 90-Day Supply | |||||
Formulary (Drug List) drug tier: | Tier #5: Tier 5 | |||||
Does this plan offer any Gap coverage? | No Gap Coverage | |||||
Does this drug have Gap coverage? | No, this drug IS NOT covered in the gap, but all drugs receive the donut hole discount. | |||||
Drug Usage Management Restrictions: | Prior Authorization | |||||
Formulary (Drug List) Tier Cost-Sharing Details | ||||||
30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
|||||
Preferred Pharmacy | Standard Pharmacy | Mail- Order** | Preferred Pharmacy | Standard Pharmacy | Mail- Order** | |
Initial $325 Deductible Cost Sharing: | ||||||
100% | 100% | 100% | 100% | 100% | 100% | |
Initial Coverage Phase Cost-Sharing: | ||||||
25% | 25% | 25% | 25% | 25% | 25% | |
Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Generics 21%): | ||||||
79% | 79% | 79% | 79% | 79% | 79% | |
Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Brand 52.5%): | ||||||
47.5% | 47.5% | 47.5% | 47.5% | 47.5% | 47.5% | |
Catastrophic Coverage Phase Cost-Sharing for Generic & Preferred Multi-Source Drugs: | ||||||
The greater of 5% or $2.65 | The greater of 5% or $2.65 | |||||
Catastrophic Coverage Phase Cost-Sharing for Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | ||||||
The greater of 5% or $6.60 | The greater of 5% or $6.60 | |||||
Your Estimated Cost for Purchases During Each Coverage Phase | ||||||
30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
|||||
Preferred Pharmacy | Standard Pharmacy | Mail- Order** | Preferred Pharmacy | Standard Pharmacy | Mail- Order** | |
Your Estimated Cost in Deductible Phase: | ||||||
$1,752.79 | $1,752.79 | $1,752.79 | $3,110.75 | $3,110.75 | $3,110.75 | |
Your Estimated Cost Initial Coverage Phase: | ||||||
$1,509.04 | $1,509.04 | $1,509.04 | $2,826.08 | $2,826.08 | $2,826.08 | |
Your Estimated Cost in Gap if Drug is Generic (21% discount): | ||||||
$3,621.18 | $3,621.18 | $3,621.18 | $4,934.59 | $4,934.59 | $4,934.59 | |
Your Estimated Cost in Gap if Drug is Brand-Name (52.5% discount): | ||||||
$2,177.29 | $2,177.29 | $2,177.29 | $2,498.04 | $2,498.04 | $2,498.04 | |
Your Estimated Cost in Catastrophic Coverage Phase (Generic): | ||||||
$229.19 | $229.19 | $229.19 | $485.22 | $485.22 | $485.22 | |
Your Estimated Cost in Catastrophic Coverage (Brand-Name or Non-Preferred Multi-Source Drugs): | ||||||
$229.19 | $229.19 | $229.19 | $485.22 | $485.22 | $485.22 | |
Tier Cost-Sharing Details and Your Costs with Explanations | ||||||
30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
|||||
Preferred Pharmacy | Standard Pharmacy | Mail- Order** | Preferred Pharmacy | Standard Pharmacy | Mail- Order** | |
--- If you purchase during the Initial Deductible Phase --- | ||||||
Initial $325 Deductible Cost Sharing: | ||||||
100% | 100% | 100% | 100% | 100% | 100% | |
Your Estimated Cost in Deductible Phase: | ||||||
$1,752.79 | $1,752.79 | $1,752.79 | $3,110.75 | $3,110.75 | $3,110.75 | |
Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
For a purchase of this drug made during the initial deductible phase, you cross over into other phases of your plan’s coverage (straddle claim). So you pay 100% of the drug cost up to your deductible of $325 and the remaining amount ($4,583.77-$325) (price - deductible) falls into your initial coverage phase (ICP). For the ICP portion of your coverage, your cost-sharing would be an additional $661.25 or $2,645.00 x 25% (overage up to your remaining coverage limit ($2,645.00) * cost-sharing). Since the amount of the retail drug price falling into the ICP $4,258.77 is greater than the remaining initial coverage limit $2645 ( - $325), $1,613.77 rolls into the coverage gap phase. For the portion that falls into the coverage gap phase, you would pay an additional $766.54 or ($1,613.77 x 47.5% -- 50% of the discount counts toward TrOOP and the 2.5% paid by your plan does not count toward TrOOP assuming this is a brand-name drug). | ||||||
--- If you purchase during the Initial Coverage Phase --- | ||||||
Initial Coverage Phase Cost-Sharing: | ||||||
25% | 25% | 25% | 25% | 25% | 25% | |
Your Estimated Cost Initial Coverage Phase: | ||||||
$1,509.04 | $1,509.04 | $1,509.04 | $2,826.08 | $2,826.08 | $2,826.08 | |
Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
The cost-sharing for purchases made during the initial coverage phase (ICP) would be $742.50 or ($2,970.00 x 25%). But since the retail drug price ($4,583.77) is greater than initial coverage limit (), the difference of $1,613.77 rolls into the coverage gap phase. For the portion that falls into the coverage gap phase, you would pay an additional $766.54 or ($1,613.77 x 47.5% -- 50% of the discount counts toward TrOOP and the 2.5% paid by your plan does not count toward TrOOP). So, your total cost for this one purchase is $1,509.04 or $742.50 (ICP) + $766.54 (Gap) . | ||||||
--- If you purchase during the Coverage Gap Phase (Donut Hole) --- | ||||||
Your Estimated Cost in Gap if Drug is Generic (21% discount): | ||||||
$3,621.18 | $3,621.18 | $3,621.18 | $4,934.59 | $4,934.59 | $4,934.59 | |
Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
Your cost is the negotiated retail price of $4,583.77 x 79%. | ||||||
Your Estimated Cost in Gap if Drug is Brand-Name (52.5% discount): | ||||||
$2,177.29 | $2,177.29 | $2,177.29 | $2,498.04 | $2,498.04 | $2,498.04 | |
Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
Your costs is the negotiated retail price of $4,583.77 x 47.5%. | ||||||
--- If you purchase during the Catastrophic Coverage Phase --- | ||||||
Catastrophic Coverage Phase Cost-Sharing for Generic & Preferred Multi-Source Drugs: | ||||||
The greater of 5% or $2.65 | The greater of 5% or $2.65 | |||||
Your Estimated Cost in Catastrophic Coverage Phase (Generic): | ||||||
$229.19 | $229.19 | $229.19 | $485.22 | $485.22 | $485.22 | |
Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
In the catastrophic coverage phase, you will pay the greater of 5% of the retail drug price or the minimum cost-share of $2.65. Calculating 5% of $4,583.77 = $229.19. Since $229.19 is more than $2.65, you would pay $229.19 for this drug at a preferred pharmacy, if it is a generic or preferred multi-source drug. | ||||||
Catastrophic Coverage Phase Cost-Sharing for Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | ||||||
The greater of 5% or $6.60 | The greater of 5% or $6.60 | |||||
Your Estimated Cost in Catastrophic Coverage (Brand-Name or Non-Preferred Multi-Source Drugs): | ||||||
$229.19 | $229.19 | $229.19 | $485.22 | $485.22 | $485.22 | |
Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
In the catastrophic coverage phase, you will pay the greater of 5% of the retail drug price or the minimum cost-share of $6.60. Calculating 5% of $4,583.77 = $229.19. Since $229.19 is more than $6.60, you would pay $229.19 for this drug at any pharmacy, if it is not a generic or preferred multi-source drug. | ||||||
HumanaChoice R5826-079 (Regional PPO) Average Negotiated Retail Drug Price History | ||||||
30-Day Supply | 90 Day Supply | |||||
October, 2013: | $4,583.77 | $9,704.46 | ||||
January, 2013: | $4,593.84 | -- | ||||
April, 2012: | $4,505.99 | -- | ||||
September, 2010: | n/a | -- | ||||
Notes:
*The Medicare drug plan’s average negotiated retail drug price is based on several variables: the medication, the quantity of your prescription, the specific Medicare Part D plan, and the pharmacies in the plan’s service area. In this case, the average of the TOPOTECAN HYDROCHLORIDE FOR INJECTION prices that the HumanaChoice R5826-079 (Regional PPO) has negotiated with each of the retail pharmacies in the plan’s service area (in Statewide, NC: CMS MA Region 7, includes: VA NC). In other words, when you use the HumanaChoice R5826-079 (Regional PPO) to purchase TOPOTECAN HYDROCHLORIDE FOR INJECTION, you may pay slightly more or slightly less than the figures shown in the table above depending on the pharmacy where you fill your prescription and the quantity of your prescription. **The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing. |
||||||
Return to the HumanaChoice R5826-079 (Regional PPO) 2013 Formulary Browser by choosing a letter below: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 |