ALIMTA 500MG VIAL (1 VIAL) (NDC: 00002762301)
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 |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.18 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-069 (PFFS)
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
HumanaChoice H5216-008 (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
HumanaChoice H5216-008 (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,773.31 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,608.49 |
Browse Plan Formulary |