NEULASTA 6MG/0.6ML SYRINGE (6 MG IN 0.6 ML SYR) (NDC: 55513019001)
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 |
Anthem Medicare Preferred Select (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $3,670.50 |
Browse Plan Formulary |
Anthem Senior Advantage Basic (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $3,670.50 |
Browse Plan Formulary |
Anthem Senior Advantage Plus (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $3,670.50 |
Browse Plan Formulary |
Anthem Senior Advantage Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $3,683.97 |
Browse Plan Formulary |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $3,671.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $3,671.15 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,438.59 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$2.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $3,670.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,505.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,522.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,466.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,466.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,536.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,536.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,517.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,517.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,444.34 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,505.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,522.27 |
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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,526.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,454.97 |
Browse Plan Formulary |
MediGold Essential Care (HMO)
|
$20.90 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,466.76 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,466.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,466.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,514.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,343.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-122 (PFFS)
|
$23.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,328.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-122 (PFFS)
|
$23.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,328.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-131 (PFFS)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,328.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-131 (PFFS)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,328.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-132 (PFFS)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,338.17 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-123 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,338.17 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,463.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,517.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,517.67 |
Browse Plan Formulary |
HumanaChoice R5826-007 (Regional PPO)
|
$28.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,342.51 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $3,583.94 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $3,583.94 |
Browse Plan Formulary |
HumanaChoice R5826-080 (Regional PPO)
|
$30.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:2 /30Days | $3,342.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediGold Network Choice (PPO)
|
$31.20 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,466.76 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,605.16 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,605.16 |
Browse Plan Formulary |
MediGold Classic Preferred (HMO)
|
$36.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $3,466.76 |
Browse Plan Formulary |
HumanaChoice H3619-012 (PPO)
|
$37.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:2 /30Days | $3,338.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,508.73 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,633.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,622.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $3,625.39 |
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 |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,536.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,536.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,510.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P S Q:1 /28Days | $3,513.23 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,605.16 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,605.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:4 /90Days | $3,441.33 |
Browse Plan Formulary |