ALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER (NDC: 00591346753)
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 |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.85 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | P Q:300 /25Days | $36.00 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
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 |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Medicare Blue (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $34.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $34.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $34.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $34.72 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $34.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $34.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | P | $40.23 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P Q:300 /25Days | $35.63 |
Browse Plan Formulary |
Southeast Community Care- Plus (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P Q:300 /25Days | $35.63 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
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 |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $35.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $35.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $35.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $35.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $35.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | P | $35.06 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (
|
$14.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | P Q:300 /25Days | $36.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
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 |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $33.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | P | $36.01 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
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 |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
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 |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
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 |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | P | $34.24 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
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 |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $45.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Comp Plus Plan (HMO
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Comp Plus Plan (HMO
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Comp Plus Plan (HMO
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Comp Plus Plan (HMO
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Comp Plus Plan (HMO
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $34.24 |
Browse Plan Formulary |
Windsor Medicare Extra Comp Plus Plan (HMO
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $34.24 |
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 |
Windsor Medicare Extra Comprehensive Plan
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $32.66 |
Browse Plan Formulary |
Windsor Medicare Extra Comprehensive Plan
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $32.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | P | $42.59 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$32.50 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:300 /25Days | $36.00 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:300 /25Days | $35.63 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:300 /25Days | $35.63 |
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 |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:300 /25Days | $35.63 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:300 /25Days | $35.63 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:300 /25Days | $35.63 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$11.00 | $27.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$12.00 | $36.00 | P | $35.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Medicare Blue Plus (PPO)
|
$42.10 |
$0 |
to be determined |
2 |
Tier 2 |
$9.00 | $22.50 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.94 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.84 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $39.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $35.40 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:300 /25Days | $32.85 |
Browse Plan Formulary |