ABRAXANE 100MG VIAL (1 X 100 MG VIALSD) (NDC: 68817013450)
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 |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
Health Plan SecureCare (HMO)
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $931.36 |
Browse Plan Formulary |
SecureChoice (PPO)
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $931.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-096 (PFFS)
|
$20.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-096 (PFFS)
|
$20.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-082 (PFFS)
|
$21.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-082 (PFFS)
|
$21.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $953.52 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $975.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 PPO Standard (PPO)
|
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $928.37 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $928.37 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $831.87 |
Browse Plan Formulary |
FreedomBlue PPO Deluxe (PPO)
|
$58.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $928.37 |
Browse Plan Formulary |