ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR (4 SYR) (NDC: 55513002704)
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 |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $3,494.19 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $3,494.19 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,360.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,409.34 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,403.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,401.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,401.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,417.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,417.30 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
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)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
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)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,347.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,409.34 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,403.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,406.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,409.30 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,409.30 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.28 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,401.72 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,401.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
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 |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.33 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,409.30 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,409.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,444.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,463.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,330.49 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $3,487.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.70 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:1 /28Days | $3,474.31 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:1 /28Days | $3,474.31 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,864.60 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,864.60 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,405.28 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,504.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $3,505.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,417.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,417.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,416.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $3,400.47 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,864.60 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,864.60 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,336.07 |
Browse Plan Formulary |