AVANDARYL 8MG-4MG TABLET (30 BOT) (NDC: 00007314913)
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 Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $113.00 | S | $243.80 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $237.17 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
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 |
Humana Gold Choice H2944-152 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $234.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $234.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $234.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $234.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $234.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $234.29 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $252.21 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $232.83 |
Browse Plan Formulary |
Southeast Community Care- Plus (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $235.90 |
Browse Plan Formulary |
Southeast Community Care- Plus (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$44.00 | $88.00 | None | $232.83 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
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 |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.34 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.34 |
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)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.34 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.34 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.34 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.34 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $235.27 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $235.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $235.27 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $235.27 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $235.27 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | S | $235.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (
|
$14.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $237.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $237.29 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.23 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
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 |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.29 |
Browse Plan Formulary |
Plan Name |
Monthly 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:90 /90Days | $237.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.29 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-148 (PFFS)
|
$20.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $256.78 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $241.15 |
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:30 /30Days | $237.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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:30 /30Days | $237.10 |
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:30 /30Days | $249.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
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:30 /30Days | $249.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
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 |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
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 |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-150 (PFFS)
|
$22.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $237.01 |
Browse Plan Formulary |
HumanaChoice H8707-001 (PPO)
|
$27.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
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 |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $235.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
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 |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-151 (PFFS)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-146 (PFFS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
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 |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
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 |
Humana Gold Choice H2944-149 (PFFS)
|
$30.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $235.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-147 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:30 /30Days | $233.06 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$32.50 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $237.17 |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$35.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $235.90 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $235.90 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $235.90 |
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 |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $235.90 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $235.90 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$35.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $235.90 |
Browse Plan Formulary |
Medicare Blue (PPO)
|
$37.80 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$37.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
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 |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete (PFFS)
|
$38.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
Browse Plan Formulary |
Guardian Tribute Enhanced (PFFS)
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $75.00 | None | $240.46 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S Q:34 /34Days | $248.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
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 |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Private Complete Plus (PFFS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | None | $235.13 |
Browse Plan Formulary |
Medicare Blue Plus (PPO)
|
$51.70 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | $100.00 | None | $235.13 |
Browse Plan Formulary |