AVANDAMET 4MG/500MG TABLET (60 BOT) (NDC: 00007316818)
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 |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | S | $243.71 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | S | $243.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | S | $243.71 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | S | $243.71 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | S | $243.71 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | S | $243.71 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | S | $243.71 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $261.88 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
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 |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | S | $244.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Sierra Optima Choice Rx (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | n/a | S Q:60 /30Days | $215.09 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.66 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $246.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
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 |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
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 |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $243.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
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 |
Humana Gold Choice H2944-056 (PFFS)
|
$33.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $245.44 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
|
$33.50 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $90.00 | S Q:60 /30Days | $243.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $258.20 |
Browse Plan Formulary |