NEUTREXIN 25MG VIAL (NDC: 58178002010)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Value (HMO-POS)
|
$7.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-044 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$20.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
|
$24.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,470.53 |
Browse Plan Formulary |
HumanaChoice H5470-004 (PPO)
|
$27.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,441.66 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | P | $1,548.20 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | P | $1,548.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$33.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-072 (Regional PPO)
|
$33.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-046 (PFFS)
|
$34.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $816.18 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $1,513.03 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $1,513.03 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $1,513.03 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
$43.00 | $129.00 | P | $1,548.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
$43.00 | $129.00 | P | $1,548.20 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
$43.00 | $129.00 | P | $1,548.20 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
$43.00 | $129.00 | P | $1,548.20 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
$43.00 | $129.00 | P | $1,548.20 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,320.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,469.25 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,320.14 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $1,443.13 |
Browse Plan Formulary |