2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Allen | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Ashland | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Ashtabula | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Belmont | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Brown | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Butler | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Carroll | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Clark | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Clermont | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Columbiana | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Cuyahoga | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Darke | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Defiance | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Delaware | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Erie | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Fairfield | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Franklin | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Fulton | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Geauga | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Greene | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Hamilton | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Hancock | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Harrison | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Henry | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Huron | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Jefferson | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Lake | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Licking | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Lorain | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Lucas | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Madison | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Mahoning | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Medina | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Miami | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Montgomery | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Muskingum | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Ottawa | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Paulding | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Portage | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Preble | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Putnam | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Sandusky | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Shelby | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Stark | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Summit | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Trumbull | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Tuscarawas | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Union | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Van Wert | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Warren | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Wayne | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Williams | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Anthem Senior Advantage Plus (HMO) in OH - H3655-030-0 Benefit Details |
Wood | $22.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $7.00 Tier 2 Preferred Brand Certain Generic Drugs: $43.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectible Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
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