ACYCLOVIR 200MG/5ML SUSP (1 PINT BOT) (NDC: 00472008216)
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 |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $104.87 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $111.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $111.31 |
Browse Plan Formulary |
Kaiser Permanente Medicare Plus Std Option
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $21.00 | None | $100.44 |
Browse Plan Formulary |
Kaiser Permanente Medicare Plus Std w/D AB
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $21.00 | None | $100.44 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.31 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (HMO)
|
$7.30 |
$100 | to be determined | 1 |
Tier 1 |
$9.00 | $23.00 | None | $111.30 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 1 |
Tier 1 |
$3.00 | $6.00 | None | $111.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 1 |
Tier 1 |
$3.00 | $6.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 1 |
Tier 1 |
$3.00 | $6.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 1 |
Tier 1 |
$3.00 | $6.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 1 |
Tier 1 |
$3.00 | $6.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 1 |
Tier 1 |
$3.00 | $6.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 1 |
Tier 1 |
$3.00 | $6.00 | None | $111.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $111.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $108.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $108.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $110.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $109.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 1 |
Tier 1 |
$2.00 | $4.00 | None | $111.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (HMO)
|
$17.60 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$17.80 |
$100* | to be determined | 2* |
Tier 2 |
$27.00 | $54.00 | None | $92.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | None | $113.38 |
Browse Plan Formulary |
Bravo Premier Plus (HMO-POS)
|
$22.20 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $111.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Select (HMO)
|
$29.40 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $111.31 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.50 | $17.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.50 | $17.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.50 | $17.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.50 | $17.00 | None | $111.31 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.50 | $17.00 | None | $111.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Specialty + Rx (HMO)
|
$30.20 |
$310* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | None | $104.87 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$33.70 |
$310 | to be determined | 1 |
Tier 1 |
25% | 25% | None | $111.31 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$33.70 |
$310 | to be determined | 1 |
Tier 1 |
25% | 25% | None | $107.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $108.69 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $108.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $110.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $110.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $109.63 |
Browse Plan Formulary |
Kaiser Permanente Medicare Plus High Optio
|
$42.40 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $21.00 | None | $100.44 |
Browse Plan Formulary |
Kaiser Permanente Medicare Plus High w/D A
|
$42.40 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $21.00 | None | $100.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $92.93 |
Browse Plan Formulary |