PROCRIT 4,000 UNITS/ML VIAL (1 ML ) (NDC: 59676030401)
2020 Medicare Prescription Drug Plan (MAPD) Information
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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 Better Health Premier Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,297.56 |
Browse Plan Formulary |
Aetna Medicare Premier (HMO)
|
$0.00 |
$0 |
No |
3 |
Tier 3 |
$47.00 | $141.00 | P | $1,297.56 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$150* |
No |
3* |
Tier 3 |
$47.00 | $141.00 | P | $1,296.96 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,260.48 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,249.20 |
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 HealthyValue (HMO)
|
$0.00 |
$250 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,335.48 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,283.64 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,222.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,248.60 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,335.48 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,249.92 |
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 Basic (HMO-POS)
|
$0.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,241.52 |
Browse Plan Formulary |
HAP Empowered MI Health Link (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,256.88 |
Browse Plan Formulary |
HAP Primary Choice Medicare (HMO)
|
$0.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,258.80 |
Browse Plan Formulary |
HAP Senior Plus (HMO)
|
$0.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,254.24 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (PPO)
|
$0.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,254.24 |
Browse Plan Formulary |
Michigan Complete Health (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,273.20 |
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 Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,250.76 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
|
$0.00 |
$75 |
No |
4 |
Tier 4 |
40% | 40% | P | $1,257.72 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,335.48 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,257.72 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,248.60 |
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 Key (HMO-POS)
|
$0.00 |
$100 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,266.24 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
|
$0.00 |
$0 |
No |
3 |
Tier 3 |
$47.00 | $94.00 | P | $1,354.68 |
Browse Plan Formulary |
WellCare Explore (HMO-POS)
|
$0.00 |
$0 |
No |
3 |
Tier 3 |
$47.00 | $94.00 | P | $1,354.68 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,326.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,222.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,248.60 |
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 Essential (PPO)
|
$9.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,283.52 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,249.92 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,266.24 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,335.48 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,257.72 |
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 Ideal (PPO)
|
$14.00 |
$125 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,248.60 |
Browse Plan Formulary |
WellCare Elite Smile (HMO-POS)
|
$14.10 |
$0 |
No |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,354.68 |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
|
$18.60 |
$435 |
No |
3 |
Tier 3 |
$47.00 | $94.00 | P | $1,354.68 |
Browse Plan Formulary |
WellCare Plus (HMO)
|
$20.60 |
$435 |
No |
3 |
Tier 3 |
$47.00 | $94.00 | P | $1,354.68 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,283.64 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,249.20 |
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 HealthySaver (HMO)
|
$23.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,335.48 |
Browse Plan Formulary |
WellCare Extra Smile (HMO-POS D-SNP)
|
$23.30 |
$435 |
No |
3 |
Tier 3 |
$47.00 | $94.00 | P | $1,354.68 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.20 |
$435 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,250.76 |
Browse Plan Formulary |
PriorityMedicare D-SNP (HMO D-SNP)
|
$30.20 |
$435 |
No |
4 |
Tier 4 |
$0.00 | $0.00 | P | $1,275.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
|
$32.00 |
$0 |
No |
3 |
Tier 3 |
$47.00 | $141.00 | P | $1,296.96 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,257.72 |
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 Value (HMO-POS)
|
$42.00 |
$75 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,266.24 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,335.48 |
Browse Plan Formulary |
WellCare Elite (HMO-POS)
|
$47.00 |
$0 |
No |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,354.68 |
Browse Plan Formulary |
BCN Advantage HMO ConnectedCare (HMO)
|
$56.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,249.20 |
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 |
HAP Senior Plus Option 2 (PPO)
|
$56.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,254.24 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (HMO-POS)
|
$76.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,254.24 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,249.92 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,326.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,222.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,248.60 |
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)
|
$76.00 |
$100 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,283.52 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,335.48 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,257.72 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
4 |
Tier 4 |
50% | 50% | P | $1,266.24 |
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 |
HAP Senior Plus Henry Ford Tiered Access (HMO)
|
$91.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,258.80 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,257.72 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,266.24 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,335.48 |
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)
|
$128.30 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,222.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,248.60 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,335.48 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,249.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,241.52 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,283.52 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,249.92 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,326.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,222.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $126.00 | P | $1,248.60 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
|
$149.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,254.24 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (HMO-POS)
|
$181.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,254.24 |
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)
|
$196.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,248.60 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,266.24 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,335.48 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
4 |
Tier 4 |
45% | 45% | P | $1,257.72 |
Browse Plan Formulary |
HAP Senior Plus Option 4 (PPO)
|
$200.00 |
$0 |
No |
3 |
Tier 3 |
$42.00 | $105.00 | P | $1,254.24 |
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)
|
$263.00 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,222.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,248.60 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,335.48 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,249.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
3 |
Tier 3 |
$38.00 | $114.00 | P | $1,241.52 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
3 |
Tier 3 |
$37.00 | $111.00 | P | $1,326.48 |
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 Assure (PPO)
|
$298.10 |
$0 |
No |
3 |
Tier 3 |
$37.00 | $111.00 | P | $1,222.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
3 |
Tier 3 |
$37.00 | $111.00 | P | $1,248.60 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
3 |
Tier 3 |
$37.00 | $111.00 | P | $1,283.52 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
3 |
Tier 3 |
$37.00 | $111.00 | P | $1,249.92 |
Browse Plan Formulary |