ABILIFY 10MG TABLET (30 BOT) (NDC: 59148000813)
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 |
Advantra Elite (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | P Q:30 /30Days | $473.23 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $140.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $140.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $140.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $140.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Classic (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $140.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $140.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
FreedomBlue PPO HD Rx (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $482.04 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.21 |
Browse Plan Formulary |
UPMC for Life PPO High Deductible with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | S Q:1 /1Days | $481.17 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | S Q:1 /1Days | $481.17 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | S Q:1 /1Days | $481.17 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | S Q:1 /1Days | $481.17 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | S Q:1 /1Days | $481.17 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | S Q:1 /1Days | $481.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityBlue Basic (HMO)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $482.04 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.72 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.72 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.72 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.72 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.72 |
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 Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.16 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CC
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.41 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.16 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.92 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.92 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.92 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $492.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $487.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.38 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.28 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $473.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.18 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $492.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.62 |
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
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.62 |
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
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $481.51 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.70 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.16 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.38 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $482.19 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
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 |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
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 |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
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 |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.38 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
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 |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
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 |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
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 |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.00 | Q:30 /30Days | $494.57 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $448.09 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $448.09 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
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 |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
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 |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $477.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $448.09 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $448.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $504.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $488.15 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $494.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $485.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:30 /30Days | $487.22 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.43 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$22.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
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 |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $479.93 |
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 |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P Q:270 /90Days | $479.12 |
Browse Plan Formulary |
FreedomBlue PPO Select (PPO)
|
$23.70 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $482.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$24.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.75 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | S Q:31 /31Days | $473.30 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | S Q:31 /31Days | $473.30 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | S Q:31 /31Days | $473.30 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | S Q:31 /31Days | $473.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $444.93 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $479.72 |
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 |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $487.42 |
Browse Plan Formulary |
SecurityBlue Standard (HMO)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $482.04 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $467.28 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.10 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $467.28 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $465.98 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $469.90 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $472.54 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $472.54 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $472.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $472.54 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $472.54 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | P Q:30 /30Days | $473.90 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $446.12 |
Browse Plan Formulary |
Gateway Health Plan Medicare Assured (HMO)
|
$32.00 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | n/a | Q:30 /30Days | $476.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $473.72 |
Browse Plan Formulary |
Unison Advantage Plus Integrated Care (HMO
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | Q:31 /31Days | $473.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.92 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.92 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$32.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $483.92 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $467.28 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
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 |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
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 |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $467.28 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.72 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
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 |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $465.98 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $471.29 |
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 |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $466.42 |
Browse Plan Formulary |
Geisinger Gold Classic 3 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $470.16 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $468.61 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$33.90 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced (HMO)
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | P Q:31 /31Days | $494.82 |
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 H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $446.55 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$34.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.10 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $446.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.38 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.62 |
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 Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $486.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $485.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $484.42 |
Browse Plan Formulary |
FreedomBlue PPO Classic (PPO)
|
$38.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $482.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.41 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $498.32 |
Browse Plan Formulary |
Geisinger Gold Secure 3 (HMO)
|
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $469.90 |
Browse Plan Formulary |
SecurityBlue Deluxe (HMO)
|
$46.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $482.04 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | P Q:31 /31Days | $494.82 |
Browse Plan Formulary |
FreedomBlue PPO Platinum (PPO)
|
$83.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $482.04 |
Browse Plan Formulary |