AMITRIP/CDP 25-10 TABLET (100 BOT) (NDC: 00378027701)
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 |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $77.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $88.19 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred NMS (
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $83.01 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred NMS (
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $83.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $84.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $85.70 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $80.42 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $84.31 |
Browse Plan Formulary |
Windsor Medicare Extra Comp Plus Plan (HMO
|
$33.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $80.42 |
Browse Plan Formulary |
Windsor Medicare Extra Comprehensive Plan
|
$33.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $80.42 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.66 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NMS (
|
$42.70 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $87.50 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NMS (
|
$42.70 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $87.50 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $83.61 |
Browse Plan Formulary |