ARCALYST INJECTION 220MG/VIAL (4 VIALSD CRTN) (NDC: 61755000101)
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $19,646.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
HumanaChoice H4956-002 (PPO)
|
$33.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |