ABILIFY INJ 9.75MG (NDC: 59148001665)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Advantra Elite (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | P | $15.85 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $17.10 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $17.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $17.10 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $17.10 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $17.10 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $17.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.52 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.52 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.52 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.52 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.52 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CC
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.32 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $16.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.35 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$14.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $17.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.44 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.12 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.00 | None | $17.16 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
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 |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
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 |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $17.20 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
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 | $17.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $18.77 |
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 | $18.77 |
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 | $18.77 |
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 | $18.77 |
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 | $18.77 |
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 | $18.35 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $18.35 |
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 | $18.35 |
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 | $18.35 |
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 | $18.35 |
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 | $18.77 |
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 | $18.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $18.77 |
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 | $18.77 |
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 | $18.77 |
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 | $18.35 |
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 | $18.35 |
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 | $18.35 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $18.35 |
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 | $18.35 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
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 | $17.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.30 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$22.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
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 H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $16.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | P | $16.59 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | P | $16.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
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 |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $16.35 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $16.35 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $16.35 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $16.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
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 H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.29 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.36 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
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 |
Bravo Premier (HMO)
|
$28.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | P | $16.59 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.86 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.88 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.13 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $17.39 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $16.03 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $15.30 |
Browse Plan Formulary |
Keystone 65 Advantage Rx (HMO)
|
$30.30 |
$280 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $16.80 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$31.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $16.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan IP (PPO)
|
$32.10 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $16.36 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:124 /31Days | $16.33 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | P | $17.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
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 |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.49 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.73 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.17 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $17.39 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $172.50 | None | $16.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $15.45 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$34.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.83 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $15.30 |
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
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.35 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.94 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:4 /1Days | $17.60 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$38.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $17.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Keystone 65 Preferred Rx (HMO)
|
$41.30 |
$100 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $16.80 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- 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 | None | $17.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $17.34 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | P | $17.40 |
Browse Plan Formulary |