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 |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$72.00 | $206.00 | None | $1,182.18 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,204.70 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,204.70 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,204.70 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,204.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network PlatinumSelect (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$26.00 | $68.00 | None | $1,260.89 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,208.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,270.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,028.34 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,259.41 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,259.41 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,259.41 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,259.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,259.41 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,259.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,203.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,203.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,201.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,207.39 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,201.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,200.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,200.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,200.86 |
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 | $1,201.14 |
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 | $1,201.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,201.14 |
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 | $1,201.14 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,182.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $1,183.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,202.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,191.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,203.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,203.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,203.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,215.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,204.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-069 (PFFS)
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,196.40 |
Browse Plan Formulary |
HumanaChoice H5216-008 (PPO)
|
$21.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,148.60 |
Browse Plan Formulary |
HumanaChoice H5216-008 (PPO)
|
$21.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,148.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.23 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,176.46 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,176.46 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,176.46 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,176.46 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,176.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,196.17 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
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 |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
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 |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $1,182.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,178.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,201.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,201.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,201.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,201.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network PlatinumPlus Pharmacy (PPO)
|
$27.90 |
$0 | to be determined | 3 |
Tier 3 |
$26.00 | $68.00 | None | $1,260.89 |
Browse Plan Formulary |
HumanaChoice H5216-003 (PPO)
|
$29.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | Q:6 /30Days | $1,191.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /30Days | $1,170.45 |
Browse Plan Formulary |
Network Cares (PPO)
|
$38.20 |
$0 | to be determined | 3 |
Tier 3 |
$0.00 | $0.00 | None | $1,260.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
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 |
Plan Name |
Monthly 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 | $1,250.53 |
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 |
Network PlatinumPremier Pharmacy (PPO)
|
$42.20 |
$0 | to be determined | 3 |
Tier 3 |
$26.00 | $68.00 | None | $1,260.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.70 |
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 |
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 |
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 |
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 |
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 |
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 |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,200.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,200.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,200.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,202.68 |
Browse Plan Formulary |