ACTONEL 5MG TABLET (30 TABLETS BOT) (NDC: 00149047101)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $116.15 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.05 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$69.00 | $138.00 | None | $115.03 |
Browse Plan Formulary |
Southeast Community Care- Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $158.00 | None | $113.54 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.82 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.45 |
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 |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.45 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.45 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Gold Rx Advantage (
|
$14.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $116.15 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
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 |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
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 |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
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 |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
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 |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
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 |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
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 |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $108.05 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$32.50 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $116.15 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $115.03 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $115.03 |
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 |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $115.03 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $115.03 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $115.03 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | S Q:30 /30Days | $117.50 |
Browse Plan Formulary |
Medicare Blue Plus (PPO)
|
$42.10 |
$0 |
to be determined |
5 |
Tier 5 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.65 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | S | $114.74 |
Browse Plan Formulary |