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 |
ATRIO Tuality MyAdvantage Companion (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | n/a |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$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 |
Health Net Violet Option 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,728.07 |
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 |
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 |
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 |
Trillium Advantage Dual SNP (HMO)
|
$7.40 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | n/a |
Browse Plan Formulary |
CareSource Silver Plus Rx (HMO)
|
$12.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$18.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$18.50 |
$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)
|
$18.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$18.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$18.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Health Net Healthy Heart (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,728.07 |
Browse Plan Formulary |
ATRIO MyAdvantage Active Rx (HMO)
|
$21.90 |
$310 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
ATRIO MyAdvantage Active Rx (HMO)
|
$21.90 |
$310 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ATRIO Tuality MyAdvantage Active Rx (HMO)
|
$21.90 |
$310 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
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 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 |
Health Net Violet Option 1 (PPO)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,728.07 |
Browse Plan Formulary |
CareOregon Advantage Star (HMO)
|
$26.40 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | n/a |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$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 H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$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 H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$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 H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$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 H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$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 H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-054 (PFFS)
|
$30.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Trillium Advantage ISNP (HMO)
|
$31.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | n/a |
Browse Plan Formulary |
ATRIO MyAdvantage II Rx (HMO)
|
$31.10 |
$310 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
ATRIO MyAdvantage II Rx (HMO)
|
$31.10 |
$310 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
ATRIO Tuality MyAdvantage II Rx (HMO)
|
$31.10 |
$310 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Regence MedAdvantage + Rx Enhanced (PPO)
|
$31.40 |
$0 |
to be determined |
5 |
Tier 5 |
30% | n/a | None | $1,744.36 |
Browse Plan Formulary |
CareOregon Advantage Plus (HMO)
|
$35.60 |
$310 |
to be determined |
2 |
Tier 2 |
41% | 41% | None | n/a |
Browse Plan Formulary |
CareSource - SNP (HMO)
|
$35.60 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
CareSource SNP Curry County (HMO)
|
$35.60 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Trillium Choice Community ISNP (HMO)
|
$35.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P | n/a |
Browse Plan Formulary |
Trillium Advantage (HMO)
|
$37.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $1,739.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Choice Advantage + Rx (HMO)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $60.00 | None | n/a |
Browse Plan Formulary |
Physicians Choice Advantage + Rx (HMO)
|
$38.10 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $60.00 | None | n/a |
Browse Plan Formulary |
CareSource Gold Plus Rx (HMO)
|
$38.20 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
CareSource Gold Plus Rx (HMO)
|
$38.20 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
CareSource Platinum Plus Rx (HMO-POS)
|
$39.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
Regence MedAdvantage + Rx Classic (PPO)
|
$41.10 |
$200 |
to be determined |
5 |
Tier 5 |
27% | n/a | None | $1,744.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
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 |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
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 |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
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 |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
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 |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
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 |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |
ODS Advantage PPORX (PPO)
|
$43.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
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 |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage II (HMO
|
$51.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | None | $1,755.83 |
Browse Plan Formulary |
CareSource Diamond Plus Rx (PPO)
|
$54.20 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
CareSource Diamond Plus Rx (PPO)
|
$54.20 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
CareSource Diamond Plus Rx (PPO)
|
$54.20 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
CareSource Diamond Plus Rx (PPO)
|
$54.20 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ATRIO MyAdvantage Choice Rx (HMO-POS)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
ATRIO MyAdvantage Choice Rx (HMO-POS)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
ATRIO Tuality MyAdvantage Choice Rx (HMO-P
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$31.00 | $62.00 | None | n/a |
Browse Plan Formulary |
Trillium Preferred ISNP (HMO)
|
$58.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $1,739.26 |
Browse Plan Formulary |
Trillium Preferred ISNP (HMO)
|
$58.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $1,739.26 |
Browse Plan Formulary |
ATRIO MyAdvantage Elite Rx (HMO-POS)
|
$59.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ATRIO MyAdvantage Elite Rx (HMO-POS)
|
$59.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | n/a |
Browse Plan Formulary |
ATRIO Tuality MyAdvantage Elite Rx (HMO-PO
|
$59.10 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | n/a |
Browse Plan Formulary |
Trillium Preferred community ISNP (HMO)
|
$59.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $1,739.26 |
Browse Plan Formulary |
Trillium Preferred community ISNP (HMO)
|
$59.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $1,739.26 |
Browse Plan Formulary |
ODS Advantage PPORX Select (PPO)
|
$86.70 |
$0 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,736.94 |
Browse Plan Formulary |