ATROPINE 0.1MG/ML SYRINGE (10 X 5 ML SYR) (NDC: 00409962905)
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 |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $26.36 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $26.36 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $26.36 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $25.92 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $25.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $25.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PPO HD Rx (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P | $24.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P | $24.31 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $27.35 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $27.35 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.19 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $26.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$10.00 | $20.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $27.35 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$7.00 | $14.00 | None | $25.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.00 | None | $23.42 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
HumanaChoice H6900-001 (PPO)
|
$18.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | P | $24.31 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $28.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $24.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
FreedomBlue PPO Select (PPO)
|
$22.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $26.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $25.92 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $25.92 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $25.92 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $27.35 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $27.35 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $27.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | P | $24.31 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $25.03 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $42.93 |
Browse Plan Formulary |
FreedomBlue PPO Classic (PPO)
|
$31.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $26.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $27.35 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $23.64 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Classic 3 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | None | $42.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $28.45 |
Browse Plan Formulary |
Geisinger Gold Secure 3 (HMO)
|
$46.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $25.03 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $23.64 |
Browse Plan Formulary |
FreedomBlue PPO Platinum (PPO)
|
$66.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $26.35 |
Browse Plan Formulary |