ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR (300MCG /0.6ML SYR) (NDC: 55513011101)
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 |
Aetna Medicare Dual Advantage Plan (HMO)
|
$0.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $6,592.19 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
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 |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
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 |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,670.65 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,602.24 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,602.24 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,602.24 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,602.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,694.77 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,947.12 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,947.12 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,947.12 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,720.81 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | P | $6,277.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $7,068.14 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,823.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,670.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
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:2 /28Days | $6,839.57 |
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:2 /28Days | $6,839.57 |
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:2 /28Days | $6,839.57 |
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:2 /28Days | $6,839.57 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,806.61 |
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:2 /28Days | $6,806.61 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,832.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,800.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,800.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $7,014.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,832.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,800.34 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,800.34 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,751.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,832.20 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,726.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,705.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (R
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,670.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,787.13 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
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:2 /28Days | $6,832.15 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
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:2 /28Days | $6,839.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,743.78 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$19.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,751.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,973.81 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
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:2 /28Days | $6,810.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,106.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,966.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $7,105.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,908.54 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P Q:7 /90Days | $6,567.10 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
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 |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
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 |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
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 |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P Q:2 /30Days | $6,670.66 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
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:2 /28Days | $6,845.59 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
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 |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
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 |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:2 /30Days | $6,670.66 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,670.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,681.46 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$27.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $6,720.81 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | P | $6,277.96 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | P | $6,277.96 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | P | $6,277.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | P | $6,277.96 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | P | $6,277.96 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,632.23 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,632.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,806.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
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 Advantage 3 powered by CCR
|
$40.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,751.77 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,592.19 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,592.19 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
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:2 /28Days | $6,827.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $6,988.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $6,996.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,013.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $7,000.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $6,996.76 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,919.70 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,919.70 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,919.70 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $6,919.70 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $6,681.46 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
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:2 /28Days | $6,832.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
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 |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
33% | 33% | P | $5,696.31 |
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:2 /28Days | $6,806.95 |
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:2 /28Days | $6,806.95 |
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:2 /28Days | $6,806.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,806.95 |
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:2 /28Days | $6,806.95 |
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:2 /28Days | $6,806.95 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,814.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,814.22 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
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:2 /28Days | $6,818.06 |
Browse Plan Formulary |