ARANESP 200MCG/ML VIAL (200MCG/ 1ML VIALSD) (NDC: 55513000601)
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $2,352.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,307.21 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,270.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,272.60 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,307.21 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,226.39 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,280.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,305.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.41 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,272.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,549.66 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,549.66 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,242.91 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $2,242.91 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,242.91 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,242.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,242.91 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,242.91 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $2,242.91 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,281.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,270.98 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,202.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,147.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,191.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,288.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,312.48 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,338.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,341.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $2,349.13 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,290.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,282.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $2,267.72 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,227.81 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | P | $2,227.81 |
Browse Plan Formulary |