ACTIQ 1600MCG LOZENGE (30 BOT) (NDC: 63459051630)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer 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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $3,361.46 |
Browse Plan Formulary |
Health Alliance Medicare HMO20 Rx (HMO)
|
$40.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO10 Rx (PPO)
|
$55.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx (PPO)
|
$55.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare HMO20 Rx Plus (HM
|
$65.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO10 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | P | $3,188.10 |
Browse Plan Formulary |