ALINIA 500MG TABLET (60 BOT) (NDC: 67546011111)
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 |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,238.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,238.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.06 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,202.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,202.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,198.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,198.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,238.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,238.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.06 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,202.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,202.77 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
Health Plan SecureCare (HMO)
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | None | $1,209.35 |
Browse Plan Formulary |
SecureChoice (PPO)
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | None | $1,209.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-096 (PFFS)
|
$20.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,175.06 |
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 |
Humana Gold Choice H2944-096 (PFFS)
|
$20.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,175.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-082 (PFFS)
|
$21.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,175.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-082 (PFFS)
|
$21.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,175.06 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,269.44 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,205.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,198.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,217.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,224.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
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 H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,186.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,171.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,203.07 |
Browse Plan Formulary |
FreedomBlue PPO Standard (PPO)
|
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,202.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,237.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,237.07 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,197.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,252.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,206.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,210.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $1,201.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,250.53 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,250.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,250.53 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,250.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,250.53 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,250.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,250.53 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,250.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,250.53 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,250.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,250.53 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,250.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,251.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,237.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,237.07 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,237.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PPO Deluxe (PPO)
|
$58.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,202.36 |
Browse Plan Formulary |