Lupron Depot-PED 1 KIT in 1 CARTON (1 KIT in 1 CARTON ) (NDC: 00074377903)
2013 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 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $5,233.44 |
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)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$20.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | P Q:1 /90Days | $5,491.58 |
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)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$90.00 | $225.00 | P | $5,452.17 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$37.50 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | P Q:1 /90Days | $5,491.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
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)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $5,233.44 |
Browse Plan Formulary |
HumanaChoice H5470-005 (PPO)
|
$62.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:1 /90Days | $5,491.58 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$72.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | P Q:1 /90Days | $5,491.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
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)
|
$75.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$89.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$80.00 | $200.00 | P | $5,452.17 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
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)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$85.00 | $212.50 | P | $5,455.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
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)
|
$151.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
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)
|
$203.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | n/a | None | $5,233.44 |
Browse Plan Formulary |