ARRANON 250MG VIAL (6 VIAL) (NDC: 00007440106)
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 | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Premier (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Value (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Value (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Value (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $3,322.24 |
Browse Plan Formulary |
Central Health Medicare Value Plan (HMO)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,372.61 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Central Health Medicare Value Plan (HMO)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,372.61 |
Browse Plan Formulary |
Central Health Medicare Value Plan (HMO)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,372.61 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $3,374.10 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Freedom Blue Plan I (Regional PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Humana Gold Choice H1804-290 (PFFS)
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Cntrl V
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | n/a | None | $3,398.92 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $3,440.91 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Freedom Blue Plus (Regional PPO)
|
$2.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete (HMO)
|
$7.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$10.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$10.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete Premier (HMO)
|
$10.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$11.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
AARP MedicareComplete (HMO)
|
$13.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 2 (HMO
|
$14.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$16.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$16.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$16.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $3,440.91 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$20.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $3,322.24 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $3,322.24 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$21.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $3,361.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$22.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $2,876.98 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$22.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Healthy Heart (HMO)
|
$23.70 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $3,288.54 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$26.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-033 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$28.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $3,337.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WHA Care+ (HMO)
|
$34.60 |
$0 | to be determined | 3 |
Tier 3 |
$95.00 | $237.50 | None | n/a |
Browse Plan Formulary |
WHA Care+ (HMO)
|
$34.60 |
$0 | to be determined | 3 |
Tier 3 |
$95.00 | $237.50 | None | n/a |
Browse Plan Formulary |
WHA Care+ (HMO)
|
$34.60 |
$0 | to be determined | 3 |
Tier 3 |
$95.00 | $237.50 | None | n/a |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-032 (PFFS)
|
$35.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
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 |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-034 (PFFS)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $3,288.54 |
Browse Plan Formulary |