AUGMENTIN XR 1000-62.5 TABLET (NDC: 00029609648)
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 |
Advantra Elite (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | None | n/a |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.88 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.88 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $432.58 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 | 4 |
Tier 4 |
$68.00 | $136.00 | None | $432.58 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $432.58 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $432.58 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $432.58 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | None | $432.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.14 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.55 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.55 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.55 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.55 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.10 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CC
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$9.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $454.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.13 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $435.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $454.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $439.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $439.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $438.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (HMO)
|
$14.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $434.07 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $438.00 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.20 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.74 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $436.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.52 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.39 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:40 /1Days | $462.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $431.65 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$22.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $435.94 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.81 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $430.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $430.38 |
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 |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $430.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $430.38 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $430.45 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $432.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.45 |
Browse Plan Formulary |
Bravo Premier (HMO)
|
$28.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $435.88 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $431.47 |
Browse Plan Formulary |
Keystone 65 Advantage Rx (HMO)
|
$30.30 |
$280 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $465.32 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$31.00 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $435.88 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$31.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $435.89 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$32.10 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $430.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$32.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.96 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $432.14 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$34.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $437.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $431.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $439.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.66 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $438.18 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$38.00 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | None | $434.07 |
Browse Plan Formulary |
Keystone 65 Preferred Rx (HMO)
|
$41.30 |
$100 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $465.32 |
Browse Plan Formulary |