TASIGNA 200MG CAPSULE 28 BLPK (28 BLPK) (NDC: 00078052651)
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 |
Aetna Medicare Dual Advantage Plan (HMO)
|
$0.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $8,228.04 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,284.04 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,284.04 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,284.04 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,284.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,284.04 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,564.13 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,564.13 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,564.13 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,564.13 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,202.41 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,564.13 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,564.13 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Molina Medicare Options (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,284.04 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | n/a | None | $7,739.06 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $8,788.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Texas Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,175.31 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,393.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,369.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,369.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
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 |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,432.08 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,432.08 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,646.50 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
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 |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,432.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,432.08 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,646.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,234.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,213.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (R
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,945.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,413.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $7,935.98 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Valley (HMO)
|
$18.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
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 |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,646.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
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 |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,398.32 |
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 |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,390.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,366.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,341.57 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,341.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,537.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,704.19 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,095.62 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,468.40 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,468.40 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,468.40 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,468.40 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,468.40 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,468.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,405.72 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,284.04 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $8,223.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $8,223.29 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $8,223.29 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$27.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $8,223.29 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,199.00 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$27.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $8,284.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,175.31 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,175.31 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,175.31 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $8,175.31 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | n/a | None | $7,739.06 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | n/a | None | $7,739.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | n/a | None | $7,739.06 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | n/a | None | $7,739.06 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 4 |
Tier 4 |
20% | n/a | None | $7,739.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,234.44 |
Browse Plan Formulary |
HumanaChoice R5826-075 (Regional PPO)
|
$33.10 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $7,945.76 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $8,184.82 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,212.04 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,212.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,369.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,369.38 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$40.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,646.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,228.04 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,228.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,391.56 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,422.25 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,659.96 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,566.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $8,629.94 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,209.20 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,209.20 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,209.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $8,209.20 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $8,199.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,356.15 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Sadler (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
33% | 33% | None | $7,022.11 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Premier (PPO
|
$50.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,374.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,363.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,412.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | S Q:120 /30Days | $8,378.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$78.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $8,333.89 |
Browse Plan Formulary |