AMIFOSTINE FOR INJECTION 500MG/VIAL (3 X 10ML VIALSU) (NDC: 62756058142)
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 |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | $24.00 | None | $1,393.52 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | $24.00 | None | $1,393.52 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | $24.00 | None | $1,393.52 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | $24.00 | None | $1,393.52 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $1,393.52 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
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 |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
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 |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
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 |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | P | $1,183.22 |
Browse Plan Formulary |