AMOCLAN 400-57MG/5 SUSPENSION RECONSTITUTED ORAL (NDC: 00143998201)
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 |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $36.56 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $36.56 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.49 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $28.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:450 /1Days | $37.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred NMS (
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $34.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred NMS (
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $34.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $29.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $23.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $44.18 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NMS (
|
$42.70 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $34.61 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NMS (
|
$42.70 |
$0 |
to be determined |
2 |
Tier 2 |
$8.50 | $25.50 | None | $34.61 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $36.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.49 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$62.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $34.10 |
Browse Plan Formulary |