ARANESP 500MCG/1ML SYRINGE (500MCG / 1ML SYR) (NDC: 55513003201)
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 |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $11,163.70 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | P Q:4 /28Days | n/a |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$250 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:1 /30Days | $11,116.70 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$250 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | P Q:1 /30Days | $11,116.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $11,821.00 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $11,821.00 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $11,821.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $11,821.00 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $11,821.00 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$27.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,173.30 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$27.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,173.30 |
Browse Plan Formulary |
Bravo Silver (HMO)
|
$32.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:1 /30Days | $11,116.70 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$34.00 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:1 /30Days | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Select (HMO)
|
$34.00 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:1 /30Days | n/a |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$34.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | P Q:1 /30Days | $11,116.70 |
Browse Plan Formulary |
Bravo Premier Plus (HMO-POS)
|
$34.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | P Q:1 /30Days | $11,116.70 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $11,317.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,316.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $11,357.30 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $11,591.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $11,591.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $11,591.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $11,591.10 |
Browse Plan Formulary |
Horizon Medicare Blue Value w/ Rx Std (HMO
|
$40.40 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:4 /84Days | $11,204.40 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $11,722.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $11,722.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $11,722.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.50 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,722.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $11,591.10 |
Browse Plan Formulary |
AmeriHealth 65 NJ Rx (HMO)
|
$46.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:30 /7Days | $12,428.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $11,173.30 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $11,173.30 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $11,173.30 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $11,173.30 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $11,173.30 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $11,173.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $11,173.30 |
Browse Plan Formulary |
Horizon Medicare Blue Value w/ Rx Enhanced
|
$66.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /84Days | $11,204.40 |
Browse Plan Formulary |
Horizon Medicare Blue Access w/ Rx Std (HM
|
$67.10 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:4 /84Days | $11,204.40 |
Browse Plan Formulary |
Horizon Medicare Blue Access w/Rx Enhanced
|
$77.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /84Days | $11,204.40 |
Browse Plan Formulary |