ARANESP 60MCG/ML VIAL (4 X 60MCG/ 1ML VIALSD) (NDC: 55513000404)
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 |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,396.78 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,396.78 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,393.27 |
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 | $1,366.50 |
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 | $1,366.50 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,366.50 |
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 | $1,366.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,376.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,381.01 |
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 | $1,387.94 |
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 | $1,387.94 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,387.94 |
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 | $1,387.94 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,408.58 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,408.58 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,359.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,359.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,372.06 |
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 | $1,372.06 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,370.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,349.76 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,376.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,381.01 |
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 | $1,366.50 |
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 | $1,366.50 |
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 | $1,366.50 |
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 | $1,366.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,371.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,371.84 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,397.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,408.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,408.58 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
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 | $1,387.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,371.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,371.84 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,375.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,376.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,433.02 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$24.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,345.26 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | P | $1,406.41 |
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 | $1,372.06 |
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 | $1,372.06 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$30.40 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $1,345.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:12 /28Days | $1,390.67 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P Q:12 /28Days | $1,390.67 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,399.22 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,399.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,373.76 |
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 | $1,373.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,399.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,407.34 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,408.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,359.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:8 /28Days | $1,359.38 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,377.83 |
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 | $1,370.94 |
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 | $1,370.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,370.94 |
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 | $1,370.94 |
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 | $1,370.94 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,399.22 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,399.22 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 | to be determined | 4 |
Tier 4 |
$90.00 | $270.00 | P Q:24 /90Days | $1,335.38 |
Browse Plan Formulary |