ANTIZOL INJECTION 1GM 4 X 1.5ML VIAL CRTN (4 X 1.5 ML VIAL CRTN) (NDC: 68727020002)
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 |
Anthem Medicare Preferred Select (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$29.00 | $58.00 | None | $6,219.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$29.00 | $58.00 | None | $6,219.88 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$29.00 | $58.00 | None | $6,219.88 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$29.00 | $58.00 | None | $6,219.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
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 |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $5,563.70 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-119 (PFFS)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,500.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-124 (PFFS)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H1806-001 (PPO)
|
$31.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
HumanaChoice R5826-082 (Regional PPO)
|
$33.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $6,360.16 |
Browse Plan Formulary |
HumanaChoice R5826-008 (Regional PPO)
|
$35.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-125 (PFFS)
|
$39.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,360.16 |
Browse Plan Formulary |