AVANDARYL 4MG/1MG TABLET (30 BOT) (NDC: 00007315113)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Choice Plan 2 (Regio
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $136.93 |
Browse Plan Formulary |
Advantage Choice POS (HMO-POS)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Advantage Plus POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | n/a |
Browse Plan Formulary |
Advantage Premium POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | Q:60 /30Days | $136.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:60 /30Days | $136.69 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$5.00 | $10.00 | None | $137.75 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.46 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.93 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $135.46 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
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 |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
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 |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
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 |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $147.13 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $140.60 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
Citrus Special Needs Plan (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Citrus Special Needs Plan (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $145.18 |
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 |
Citrus Special Needs Plan (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Citrus Special Needs Plan (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $145.18 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | Q:60 /30Days | $144.41 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | S | $136.91 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.93 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.93 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.91 |
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 |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.91 |
Browse Plan Formulary |
Freedom VIP Care (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.77 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.77 |
Browse Plan Formulary |
Freedom VIP Savings (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.76 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | S Q:60 /30Days | $137.76 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.81 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.81 |
Browse Plan Formulary |
Humana Gold Plus H5426-008 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Direct
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$20.00 | n/a | Q:60 /30Days | $142.61 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | Q:180 /90Days | $138.52 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | Q:180 /90Days | $138.52 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | Q:180 /90Days | $138.52 |
Browse Plan Formulary |
Molina Medicare Options Broward (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $137.70 |
Browse Plan Formulary |
Molina Medicare SmartSaver (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $137.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $138.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $138.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $138.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $138.10 |
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 |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $138.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | S Q:60 /30Days | $137.70 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | Q:60 /30Days | $141.05 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | Q:60 /30Days | $141.05 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | Q:60 /30Days | $138.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | Q:60 /30Days | $138.26 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | Q:60 /30Days | $138.26 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | Q:60 /30Days | $138.26 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | Q:60 /30Days | $138.26 |
Browse Plan Formulary |
Preferred Care Partners Senior Health Choi
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $138.28 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $240.00 | S | $136.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PUP Rewards (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | S | $136.93 |
Browse Plan Formulary |
Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $136.90 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:60 /30Days | $137.18 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:60 /30Days | $137.18 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:60 /30Days | $137.18 |
Browse Plan Formulary |
Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:60 /30Days | $137.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VISTA Platinum Choice (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:60 /30Days | $137.11 |
Browse Plan Formulary |
VISTA Platinum Choice (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:60 /30Days | $137.11 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:180 /90Days | $138.52 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:180 /90Days | $138.52 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:180 /90Days | $138.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.55 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.55 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.55 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $137.25 |
Browse Plan Formulary |
Evercare Plan RDP (Regional PPO)
|
$19.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | S | $136.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:60 /30Days | $141.05 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:60 /30Days | $141.05 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | S | $136.94 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | S | $136.94 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | S | $136.94 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | S | $136.94 |
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 |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | S | $136.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $140.64 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $136.99 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $136.99 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $136.99 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $136.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:60 /30Days | $147.33 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $140.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $137.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $137.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $137.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $137.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $137.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $137.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $141.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $142.34 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $142.34 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $142.34 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $138.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-139 (PFFS)
|
$24.60 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $136.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.63 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$28.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $135.62 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $137.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 (PPO)
|
$30.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $137.25 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$32.70 |
$90 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$35.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days | $135.62 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $137.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.90 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-143 (PFFS)
|
$38.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $136.11 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $136.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $136.92 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $137.19 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $137.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $145.28 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $145.28 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $145.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $145.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $145.28 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $145.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:68 /34Days | $145.28 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $137.12 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $137.12 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $137.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:60 /30Days | $135.60 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | S | $137.24 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $137.12 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $137.12 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $137.12 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $138.46 |
Browse Plan Formulary |