ARIXTRA 10MG SYRINGE (10 X .8 ML SYR) (NDC: 00007323611)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
AARP MedicareComplete Premier (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Value (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
AARP MedicareComplete Value (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
AARP MedicareComplete Value (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
AARP MedicareComplete Value (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,237.69 |
Browse Plan Formulary |
Care1st Medicare Advantage Gold Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $1,243.71 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care1st Medicare Advantage Gold Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $1,243.71 |
Browse Plan Formulary |
Care1st Medicare Advantage Value Plan (HMO
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $1,243.71 |
Browse Plan Formulary |
Care1st Medicare Advantage Value Plan (HMO
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | P | $1,243.71 |
Browse Plan Formulary |
Central Health Medicare Value Plan (HMO)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:24 /30Days | $1,356.74 |
Browse Plan Formulary |
Central Health Medicare Value Plan (HMO)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:24 /30Days | $1,356.74 |
Browse Plan Formulary |
Central Health Medicare Value Plan (HMO)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:24 /30Days | $1,356.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:11 /28Days | $1,243.22 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Freedom Blue Plan I (Regional PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Humana Gold Choice H1804-290 (PFFS)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,229.58 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | n/a | None | $1,087.96 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Cntrl V
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | n/a | None | $1,098.41 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Sac., S
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | n/a | None | $1,086.26 |
Browse Plan Formulary |
SCAN Health Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,307.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,236.73 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,236.73 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,236.73 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,236.73 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,236.73 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,236.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SCAN Health Plan (HMO)
|
$0.60 |
$310 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,069.93 |
Browse Plan Formulary |
SCAN Health Plan (HMO)
|
$0.60 |
$310 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,309.14 |
Browse Plan Formulary |
SCAN Health Plan (HMO)
|
$0.70 |
$310 | to be determined | 5 |
Tier 5 |
25% | n/a | None | $1,307.38 |
Browse Plan Formulary |
Freedom Blue Plus (Regional PPO)
|
$2.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
AARP MedicareComplete (HMO)
|
$7.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,286.49 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$10.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$10.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,238.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Premier (HMO)
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$11.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
AARP MedicareComplete (HMO)
|
$12.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,228.54 |
Browse Plan Formulary |
AARP MedicareComplete (HMO)
|
$13.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,286.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:24 /30Days | $1,262.63 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,245.85 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$16.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$16.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$16.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$20.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,242.33 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,240.43 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,244.46 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,242.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,278.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,275.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,430.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:24 /365Days | $1,267.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,328.54 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$22.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,244.46 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$23.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,247.97 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,242.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Healthy Heart Plan 2 (HMO)
|
$26.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,242.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$28.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:8 /10Days | $1,247.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Senior Advantage Medicare Medi-Cal Plan No
|
$28.20 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | n/a | None | $1,087.96 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,244.49 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$28.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $1,245.36 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$28.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $1,245.36 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$28.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $1,244.49 |
Browse Plan Formulary |
Arcadian Community Care - Dual Plus (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $1,228.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arcadian Community Care - Dual Plus (HMO)
|
$29.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $1,228.10 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$29.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,228.10 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$29.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,228.10 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$29.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,228.10 |
Browse Plan Formulary |
Arcadian Community Care - Enhanced (HMO)
|
$29.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,228.10 |
Browse Plan Formulary |
WHA Care+ (HMO)
|
$34.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WHA Care+ (HMO)
|
$34.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
WHA Care+ (HMO)
|
$34.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,244.16 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,257.87 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,260.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,255.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,308.77 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,306.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,305.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,256.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:24 /30Days | $1,262.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,232.34 |
Browse Plan Formulary |