AMIFOSTINE FOR INJECTION 500MG/VIAL (3 X 10ML VIALSU) (NDC: 62756058142)
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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PPO HD Rx (PPO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
FreedomBlue PPO Basic Rx (PPO)
|
$18.80 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,309.79 |
Browse Plan Formulary |
FreedomBlue PPO Standard (PPO)
|
$21.20 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $1,416.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,319.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,436.76 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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 |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,309.79 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
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 |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $1,444.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
FreedomBlue PPO Deluxe (PPO)
|
$51.80 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $15.00 | None | $1,416.44 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,256.54 |
Browse Plan Formulary |