ALOCRIL 2% EYE DROPS (5 ML BOTDR) (NDC: 00023884205)
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 |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | None | $86.40 |
Browse Plan Formulary |
Medicare Blue (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.11 |
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 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.33 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.33 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:10 /30Days | $91.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$69.00 | $138.00 | None | $85.64 |
Browse Plan Formulary |
Southeast Community Care- Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $158.00 | None | $84.54 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.26 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.26 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.26 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.26 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.26 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.32 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $85.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $85.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.39 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.39 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.39 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.39 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.39 |
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 |
Care Improvement Plus Gold Rx Advantage (
|
$14.00 |
$0 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | None | $86.40 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.21 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.21 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $86.21 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.21 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.21 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.21 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $85.11 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $87.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $89.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $90.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.39 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.39 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.39 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.39 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $86.39 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$32.50 |
$0 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | None | $86.40 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $85.65 |
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 |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $85.65 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $85.65 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $85.65 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $85.65 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$37.90 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | None | $85.44 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Plus (PPO)
|
$42.10 |
$0 |
to be determined |
5 |
Tier 5 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.35 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | $187.50 | None | $85.54 |
Browse Plan Formulary |