ATGAM 50MG/ML AMPUL (5 X 5 ML AMP) (NDC: 00009722402)
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
HealthPartners Freedom Plan II Standard Rx
|
$7.10 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,893.39 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
HealthPartners Freedom Plan III StandardRx
|
$14.60 |
$100* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
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 |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,806.00 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,832.30 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,419.29 |
Browse Plan Formulary |
UCare Connect (HMO)
|
$32.60 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,419.29 |
Browse Plan Formulary |
UCare's Minnesota Senior Health Options (H
|
$32.60 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,419.29 |
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 |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
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 |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
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 |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
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 |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
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 |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
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 |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,832.30 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
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 |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $2,765.27 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Std Rx - MN
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std. Rx -
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,403.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Enhanced
|
$67.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $2,832.30 |
Browse Plan Formulary |
HealthPartners Freedom Plan III EnhancedRx
|
$167.50 |
$125* |
to be determined |
3* |
Tier 3 |
25% | n/a | P | $2,806.00 |
Browse Plan Formulary |