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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,275.76 |
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 |
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 |
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 |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,316.17 |
Browse Plan Formulary |
HumanaChoice H6609-005 (PPO)
|
$36.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $1,316.17 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$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 |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Basic w/Std Rx - MN
|
$38.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std. Rx -
|
$38.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Enhanced
|
$67.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,316.17 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1,284.02 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1,284.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1,284.02 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1,284.02 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1,284.02 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1,284.02 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1,284.02 |
Browse Plan Formulary |