ABILIFY 30MG TABLET (30 BOT) (NDC: 59148001113)
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 |
Choices 65 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$50.00 | $100.00 | None | $674.00 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-009 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Plus H1951-001 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $175.00 | Q:30 /30Days | $626.43 |
Browse Plan Formulary |
Humana Gold Plus H1951-001 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $175.00 | Q:30 /30Days | $626.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareComplete Plus (HMO-
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | S Q:31 /31Days | $666.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | S Q:31 /31Days | $668.58 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $714.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $681.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.34 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.34 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $680.11 |
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 | $680.11 |
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 | $680.11 |
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 | $680.11 |
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 | $680.11 |
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 | $680.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $680.11 |
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 | $680.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $684.44 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $677.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.07 |
Browse Plan Formulary |
Humana Gold Plus H1951-013 (HMO)
|
$18.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $622.15 |
Browse Plan Formulary |
Humana Gold Plus H1951-013 (HMO)
|
$18.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $622.15 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Arcadian Community Care - Plus Point (HMO-
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
$79.00 | $158.00 | None | $673.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $688.56 |
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 | $688.56 |
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 | $688.56 |
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 | $699.48 |
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 | $699.48 |
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 | $699.48 |
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 |
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 | $699.48 |
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 | $699.48 |
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 | $684.45 |
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 | $684.45 |
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 | $684.45 |
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 | $699.48 |
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 |
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 | $699.48 |
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 | $699.48 |
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 | $699.48 |
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 | $699.48 |
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 | $684.45 |
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 | $684.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $684.45 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
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 | $684.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $684.49 |
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 | $684.49 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | Q:90 /90Days | $676.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
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 |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Choice H1906-001 (PFFS)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.48 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1951-017 (HMO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$95.00 | $237.50 | Q:30 /30Days | $626.43 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1951-017 (HMO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$95.00 | $237.50 | Q:30 /30Days | $626.43 |
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 |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
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 |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
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 |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$31.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $673.92 |
Browse Plan Formulary |
HumanaChoice R5826-078 (Regional PPO)
|
$31.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $625.88 |
Browse Plan Formulary |
Secure Health (HMO)
|
$31.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $674.01 |
Browse Plan Formulary |
HumanaChoice R5826-011 (Regional PPO)
|
$34.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $625.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $684.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $684.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | $704.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $705.01 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | Q:34 /34Days | $704.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $680.11 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
AAA2 Vantage BASIC (HMO-POS)
|
$49.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $240.00 | None | $680.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.34 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $683.73 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $682.51 |
Browse Plan Formulary |