REBIF TITRTN SOL PACK 8.8MCG/22 VIAL (NDC: 44087882201)
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 |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,717.48 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | P | $3,091.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | P | $3,091.36 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
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 |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
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 |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
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 |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $2,717.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,025.25 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,025.25 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,738.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,025.25 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,025.25 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,780.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,780.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,780.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,780.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,780.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,780.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,914.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,736.64 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,684.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,716.45 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $2,927.49 |
Browse Plan Formulary |
HumanaChoice R5826-001 (Regional PPO)
|
$36.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:12 /30Days | $2,709.63 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,818.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,841.62 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P Q:12 /28Days | $2,813.56 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $2,700.34 |
Browse Plan Formulary |