ZALEPLON 5MG CAPSULE (100 BOT) (NDC: 65862021401)
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 |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | Q:31 /31Days | $22.98 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | Q:31 /31Days | $22.98 |
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 |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | Q:31 /31Days | $22.98 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | Q:31 /31Days | $22.98 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | Q:31 /31Days | $22.98 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | Q:31 /31Days | $22.98 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | Q:31 /31Days | $22.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:30 /30Days | $18.79 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | Q:31 /31Days | $22.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Sierra Optima Choice Rx (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:30 /30Days | $80.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
HumanaChoice H4606-001 (PPO)
|
$23.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.89 |
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 |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $16.17 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $84.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:34 /34Days | $39.86 |
Browse Plan Formulary |