ACARBOSE 100MG TABLET S (NDC: 16252052501)
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 |
1 |
Tier 1 |
$4.00 | $10.00 | None | $23.59 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$0.00 | $0.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
FreedomBlue PPO HD Rx (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.37 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | $28.90 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | $28.90 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | $28.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | $28.90 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | $28.90 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | $28.90 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.11 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.11 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.11 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.11 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CC
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.07 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.23 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.92 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.92 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.92 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | S | $25.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Today's Options Advantage 3 powered by CCR
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.26 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.12 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.71 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.48 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
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 |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
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 |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
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 |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
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 |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.40 |
Browse Plan Formulary |
FreedomBlue PPO Basic Rx (PPO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $0.00 | None | $26.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $0.00 | None | $26.67 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | None | $28.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$21.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $29.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $26.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $26.67 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $29.74 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.57 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$22.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.07 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | Q:270 /90Days | $23.40 |
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 |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | Q:270 /90Days | $24.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.15 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | S | $25.34 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | S | $25.34 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | S | $25.34 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | S | $25.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $28.43 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.50 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.60 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.50 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.03 |
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 |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.89 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
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 |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
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 |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.08 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.08 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.08 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.08 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $28.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
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 |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
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 |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $23.59 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $27.42 |
Browse Plan Formulary |
Geisinger Gold Secure 1 (HMO)
|
$32.00 |
$310* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $28.44 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $25.23 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.92 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.92 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $23.92 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.50 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
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 |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
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 |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.50 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
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 |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
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 |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.21 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
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 |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.16 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.03 |
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 |
Geisinger Gold Classic 3 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.47 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
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 |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
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 |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
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 |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
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 |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.17 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$34.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.07 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $27.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.05 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:90 /30Days | $24.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.36 |
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 |
Geisinger Gold Secure 3 (HMO)
|
$46.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $28.17 |
Browse Plan Formulary |
FreedomBlue PPO Deluxe (PPO)
|
$51.80 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $29.84 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $24.11 |
Browse Plan Formulary |