Humira 2 KIT per CARTON / 1 KIT in 1 KIT (2 KIT in 1 CARTON / 1 KIT ) (NDC: 00074379902)
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 |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $2,769.48 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $2,769.48 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | Few Generics | 4 |
Specialty Tier |
33% | 33% | P Q:6 /28Days | $2,762.83 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,795.38 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 6 |
Specialty Tier |
33% | 33% | P | $2,767.01 |
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 |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $2,767.01 |
Browse Plan Formulary |
Brand New Day Dementia with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $2,815.04 |
Browse Plan Formulary |
Brand New Day Diabetes with Enhanced Drug Benefits (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $2,815.04 |
Browse Plan Formulary |
Brand New Day Enhanced Drug Savings for So Cal (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $2,815.04 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | 30% | P | $2,747.77 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | 30% | P | $2,751.52 |
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 |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,852.04 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$310 | Many Generics | 5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $2,852.07 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,852.04 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,852.04 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,852.04 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,851.96 |
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 |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,852.04 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,837.34 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | All Generics | 5 |
Specialty Tier |
33% | 33% | P Q:8 /28Days | $2,837.34 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $2,764.86 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $2,752.42 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Specialty Tier |
33% | 33% | P Q:2 /28Days | $2,769.22 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | 33% | P | $2,751.43 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | 33% | P | $2,751.05 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | 33% | P | $2,751.43 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | 33% | P | $2,751.05 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | 33% | P | $2,751.11 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | 33% | P | $2,751.43 |
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 |
Health Net Seniority Plus Ruby (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | 33% | P | $2,751.05 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P | $2,795.38 |
Browse Plan Formulary |
Humana Gold Plus H0108-011 (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,730.31 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | n/a | P Q:8 /28Days | $2,837.34 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 5 |
Specialty Tier |
25% | 25% | None | $2,304.64 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
25% | n/a | P | $2,745.53 |
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 |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P | $2,795.38 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P | $2,798.18 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P | $2,799.15 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$4.00 |
$0 | to be determined | 5 |
Specialty Tier |
25% | 25% | None | $2,317.09 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$14.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | None | $2,317.09 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$16.20 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $2,777.23 |
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 |
Care1st TotalDual Plan (HMO SNP)
|
$20.70 |
$310 | Few Generics | 5 |
Specialty Tier |
25% | 25% | P | $2,745.53 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$21.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $2,757.48 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$24.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
n/a | n/a | P | $2,798.18 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$24.40 |
$310 | Call plan for details | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $2,745.53 |
Browse Plan Formulary |
Coordinated Choice Plan (HMO)
|
$26.30 |
$310 | Few Generics | 5 |
Specialty Tier |
25% | 25% | P | $2,758.15 |
Browse Plan Formulary |
SCAN Plus (HMO)
|
$28.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $2,801.45 |
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 |
Brand New Day Dementia with Extra Care (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:4 /28Days | $2,815.04 |
Browse Plan Formulary |
Brand New Day Diabetes with Extra Care (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:4 /28Days | $2,815.04 |
Browse Plan Formulary |
Brand New Day Dual Coverage (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:4 /28Days | $2,815.04 |
Browse Plan Formulary |
Brand New Day Extra Care (HMO)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:4 /28Days | $2,815.18 |
Browse Plan Formulary |
Brand New Day for Mental Illness (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:4 /28Days | $2,815.18 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$28.10 |
$310 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:8 /28Days | $2,837.34 |
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 |
Central Health Premier Plan (HMO)
|
$28.10 |
$310 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:8 /28Days | $2,837.34 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P | $2,751.11 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P | $2,751.30 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | P Q:4 /28Days | $2,803.26 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
n/a | n/a | P | $2,798.18 |
Browse Plan Formulary |
VillageHealth (HMO SNP)
|
$28.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $2,795.38 |
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 |
Inter Valley Health Plan Total Fit (HMO)
|
$30.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:8 /28Days | $2,837.34 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$80.00 |
$149* | No additional gap coverage, only the Donut Hole Discount | 6* |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $2,798.18 |
Browse Plan Formulary |