ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU (1 VIALSU) (NDC: 00173013093)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Anthem Medicare Preferred Select (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | $1,657.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | $1,657.52 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | $1,657.52 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P | $1,657.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Humana Gold Plus H2012-009 (HMO)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
ADVANTAGE Preferred Network Basic (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Network Basic (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ADVANTAGE Preferred Network Basic (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Network Basic (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Network Basic (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MP (PPO)
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$22.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
ADVANTAGE Preferred Network Enhanced (HMO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
Wishard Complete Care Enhanced (HMO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Basic (PPO
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
HumanaChoice R5826-082 (Regional PPO)
|
$33.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-008 (Regional PPO)
|
$35.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$35.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,774.49 |
Browse Plan Formulary |
HumanaChoice H1510-001 (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
ADVANTAGE Preferred Plus Part D Enhanced (
|
$40.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |
ADVANTAGE Enhanced Plus (PPO)
|
$53.30 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | P | $1,640.00 |
Browse Plan Formulary |