AREDIA 30MG VIAL (4 CRTN) (NDC: 00078046391)
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 |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $843.31 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-012 (HMO)
|
$34.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 4 |
Tier 4 |
$55.00 | $137.50 | None | $1,011.51 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:8 /30Days | $963.52 |
Browse Plan Formulary |