AMBISOME 50MG VIAL (20 CC VIALSU) (NDC: 00469305130)
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,668.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,650.00 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,695.61 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-097 (PFFS)
|
$20.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-098 (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-079 (PFFS)
|
$22.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
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 |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,716.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,656.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,656.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,642.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,642.91 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,642.91 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-078 (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Evercare Plan IH-POS (HMO-POS)
|
$34.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,695.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
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 |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |
Optima Medicare Preferred Plus (PPO)
|
$69.20 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,631.11 |
Browse Plan Formulary |