ABILIFY DISCMELT 10MG TABLET (3 X 10 CRTN) (NDC: 59148064023)
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 |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $573.62 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H2012-006 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.29 |
Browse Plan Formulary |
Medicare Blue (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $563.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $563.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $563.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $563.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $563.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $563.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $598.33 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$69.00 | $138.00 | None | $558.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care- Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $158.00 | None | $558.22 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $574.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $574.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $574.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $574.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $574.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $574.38 |
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 | $581.51 |
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 | $581.51 |
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 | $581.51 |
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 | $581.51 |
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 | $581.51 |
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
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $578.54 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $575.83 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $582.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $582.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $583.78 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $583.78 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $575.83 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $582.15 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $582.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $577.28 |
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 | $577.28 |
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 | $577.28 |
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 | $577.28 |
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 | $577.17 |
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 | $577.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $577.17 |
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 | $577.17 |
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 | $577.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $577.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $564.17 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $564.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $564.17 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $564.17 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $564.17 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | S Q:62 /31Days | $564.17 |
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 | $586.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $573.21 |
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 | $578.48 |
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 | $578.48 |
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 | $578.48 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:30 /30Days | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (
|
$14.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $573.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $570.91 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $570.91 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:270 /90Days | $570.91 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $572.35 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $570.91 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $570.91 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $570.91 |
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 | $578.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $582.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $581.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $581.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $581.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $581.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $581.51 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
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 H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
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 H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | Q:60 /30Days | $562.08 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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 | $580.30 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
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:60 /30Days | $593.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $593.72 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $575.20 |
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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
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:60 /30Days | $573.27 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P Q:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
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:60 /30Days | $600.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:270 /90Days | $573.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:30 /30Days | $577.03 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | S | $565.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $528.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $533.79 |
Browse Plan Formulary |
HumanaChoice H8707-005 (PPO)
|
$30.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $527.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
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 H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
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 H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days | $530.48 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$32.50 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $573.62 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $558.22 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $558.22 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $558.22 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $558.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $558.22 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | Q:60 /30Days | $566.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | None | $576.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Medicare Blue Plus (PPO)
|
$42.10 |
$0 |
to be determined |
5 |
Tier 5 |
$75.00 | $187.50 | None | $563.96 |
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 | $577.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $577.17 |
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 | $577.17 |
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 | $577.17 |
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 | $577.17 |
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 | $586.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.09 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $590.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | Q:68 /34Days | $591.81 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $567.17 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $563.96 |
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 | $577.28 |
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 | $577.28 |
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 | $577.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $577.28 |
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 | $578.48 |
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 | $578.48 |
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 | $578.48 |
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 | $585.89 |
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 | $585.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $585.89 |
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 | $585.89 |
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 | $585.89 |
Browse Plan Formulary |