ACTONEL 30MG TABLET (30 BOT) (NDC: 00149047001)
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 |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
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 |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
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 |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $222.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $791.69 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $791.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $791.69 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $791.69 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $791.69 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $791.69 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $791.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.35 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.95 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.95 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.95 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.95 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $792.09 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
Browse Plan Formulary |
Sierra Optima Choice Rx (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | P Q:30 /30Days | $654.03 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $746.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $758.46 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
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 |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
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 |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
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 |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
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 |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | S Q:30 /30Days | $793.12 |
Browse Plan Formulary |