ASACOL HD DELAYED RELEASE TABLETS 800MG 180 BOT (NDC: 00149078301)
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 |
Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:150 /30Days | $666.33 |
Browse Plan Formulary |
Advantage Health Florida (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:150 /30Days | $666.33 |
Browse Plan Formulary |
Advantage Silver - East (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:150 /30Days | $666.33 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:180 /30Days | $601.57 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:180 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:180 /30Days | $601.57 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:180 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:180 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:180 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-001 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5426-008 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | None | $641.98 |
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 |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | None | $641.98 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $603.76 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $603.76 |
Browse Plan Formulary |
Value One Florida (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:150 /30Days | $666.33 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $641.98 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $641.98 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $641.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | None | $673.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | None | $603.76 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | None | $603.76 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H5426-013 (HMO)
|
$22.60 |
$310 |
to be determined |
2 |
Tier 2 |
$37.00 | $92.50 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $641.98 |
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 |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-139 (PFFS)
|
$24.60 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$28.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$32.70 |
$90 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$33.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-005 (Regional PPO)
|
$35.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
4 |
Tier 4 |
$82.00 | $164.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Humana Gold Choice H2944-143 (PFFS)
|
$38.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $554.11 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $554.11 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:360 /30Days | $601.57 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $646.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $673.66 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $180.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $180.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $180.00 | S Q:6 /1Days | $643.72 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
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 |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $641.98 |
Browse Plan Formulary |