PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY (24 X 1 ML TRAY) (NDC: 59676032004)
2015 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 |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:12 /28Days | $1,820.40 |
Browse Plan Formulary |
Anthem Dual Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Dual Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | P Q:12 /28Days | $1,826.65 |
Browse Plan Formulary |
Anthem Senior Advantage Basic (HMO)
![Email Prescription and/or Health Benefit details for Anthem Senior Advantage Basic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$153* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,827.30 |
Browse Plan Formulary |
CareSource MyCare Ohio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for CareSource MyCare Ohio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Brand Drugs |
0% | 0% | P | $1,810.81 |
Browse Plan Formulary |
Gateway Health Medicare Assured Select (HMO)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | P | $1,832.10 |
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 |
HealthSpan Medicare Standard (HMO)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Standard (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | P | $1,812.77 |
Browse Plan Formulary |
Humana Gold Plus H8953-006 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8953-006 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$320 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
25% | n/a | P Q:14 /30Days | $1,792.00 |
Browse Plan Formulary |
PrimeTime Health Plan Aultimate (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Aultimate (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,810.78 |
Browse Plan Formulary |
SecureCare - Option IV (HMO)
![Email Prescription and/or Health Benefit details for SecureCare - Option IV (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Specialty Tier |
33% | n/a | P | $1,858.98 |
Browse Plan Formulary |
SummaCare Medicare Topaz (HMO)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Topaz (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100* |
to be determined |
5* |
Tier 5 |
33% | 33% | P Q:12 /28Days | $1,810.44 |
Browse Plan Formulary |
UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Brand Drugs |
0% | 0% | P | $1,830.47 |
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 |
HealthSpan Medicare Core 2 (HMO)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Core 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$2.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P | $1,812.75 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $1,825.26 |
Browse Plan Formulary |
HealthSpan Medicare Plus IV (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus IV (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | P | $1,810.12 |
Browse Plan Formulary |
Buckeye Health Plan Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Buckeye Health Plan Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | P | $1,835.16 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Diamond (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | P | $1,832.10 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Ruby (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | P | $1,832.10 |
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 |
SecureCare SNP (HMO SNP)
![Email Prescription and/or Health Benefit details for SecureCare SNP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P | $1,858.98 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P | $1,822.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | 33% | P | $1,834.95 |
Browse Plan Formulary |
PrimeTime Health Plan Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,810.78 |
Browse Plan Formulary |
SummaCare Medicare Ruby (HMO)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Ruby (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:12 /28Days | $1,812.58 |
Browse Plan Formulary |
HumanaChoice R5826-007 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-007 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | P Q:14 /30Days | $1,803.67 |
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 |
HealthSpan Medicare Plus III (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus III (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | P | $1,810.12 |
Browse Plan Formulary |
Gateway Health Medicare Assured Gold (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Gold (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | P | $1,832.10 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
![Email Prescription and/or Health Benefit details for Blue Medicare Access Value (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.80 |
$115* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,825.68 |
Browse Plan Formulary |
HealthSpan Medicare Plus II (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus II (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.10 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | P | $1,810.12 |
Browse Plan Formulary |
HealthSpan Medicare Enhanced (HMO)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Enhanced (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | P | $1,812.77 |
Browse Plan Formulary |
HealthSpan Medicare Plus I - B only (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus I - B only (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,810.12 |
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 |
Gateway Health Medicare Assured Choice (HMO)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | P | $1,832.10 |
Browse Plan Formulary |
Anthem Senior Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem Senior Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$64.00 |
$123* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,822.86 |
Browse Plan Formulary |
SecureCare - Option II (HMO)
![Email Prescription and/or Health Benefit details for SecureCare - Option II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$66.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Specialty Tier |
33% | n/a | P | $1,858.98 |
Browse Plan Formulary |
PrimeTime Health Plan Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,810.78 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$71.00 |
$165* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,840.89 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$71.00 |
$165* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,848.26 |
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 H6609-082 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H6609-082 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$320 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
25% | n/a | P Q:14 /30Days | $1,789.51 |
Browse Plan Formulary |
Gateway Health Medicare Assured Platinum (HMO SNP)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Platinum (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | P | $1,832.10 |
Browse Plan Formulary |
SummaCare Medicare Sapphire (HMO-POS)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Sapphire (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:12 /28Days | $1,812.58 |
Browse Plan Formulary |
Gateway Health Medicare Assured Prime (HMO)
![Email Prescription and/or Health Benefit details for Gateway Health Medicare Assured Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$82.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | P | $1,832.10 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$91.00 |
$151* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,837.69 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$91.00 |
$151* |
No additional gap coverage, only the Donut Hole Discount |
5* |
Specialty Tier |
33% | n/a | P Q:12 /28Days | $1,833.04 |
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 Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$100.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:12 /28Days | $1,820.72 |
Browse Plan Formulary |
Aetna Medicare Select Plus Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plus Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$139.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $112.50 | P Q:12 /28Days | $1,821.12 |
Browse Plan Formulary |
HealthSpan Medicare Plus I (Cost)
![Email Prescription and/or Health Benefit details for HealthSpan Medicare Plus I (Cost)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,810.12 |
Browse Plan Formulary |
SummaCare Medicare Emerald (HMO-POS)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Emerald (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$182.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:12 /28Days | $1,812.58 |
Browse Plan Formulary |