REBIF 44ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS (12 SYRINGE, GLASS in 1 CA ) (NDC: 44087004403)
2014 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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
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 |
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | 25% | None | $4,946.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$17.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
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 |
HumanaChoice R5826-006 P (Regional PPO)
|
$30.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:12 /28Days | $4,914.50 |
Browse Plan Formulary |
HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)
|
$32.50 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | None | $4,946.03 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$60.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,021.41 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$80.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $4,875.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$94.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $4,818.36 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 1 (HMO-POS)
|
$98.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | None | $4,946.55 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,003.16 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $4,995.29 |
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 |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,011.63 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,021.41 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$99.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $4,988.78 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$138.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,021.41 |
Browse Plan Formulary |
HealthPlus MedicarePlus AdvantageHMO-POS Option 2 (HMO-POS)
|
$150.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | None | $4,946.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$155.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $4,988.78 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,003.16 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $4,995.29 |
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 |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,011.63 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$165.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $5,021.41 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$268.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P | $4,818.36 |
Browse Plan Formulary |