CARDENE IV INJECTION 2.5MG/ML 10 X 10 ML AMP (10 X 10 ML AMP) (NDC: 24477003025)
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 |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $2,481.13 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,114.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1468-007 (HMO)
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-011 (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-011 (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-012 (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-014 (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $2,416.68 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,481.13 |
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 |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,481.13 |
Browse Plan Formulary |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-010 (PPO)
|
$26.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HealthSpring TotalCare (HMO)
|
$28.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $2,481.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-043 (PFFS)
|
$31.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice R5826-009 (Regional PPO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $2,416.68 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $2,485.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $2,485.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $2,485.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $2,485.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $2,485.07 |
Browse Plan Formulary |
Health Alliance Medicare PPO10 Rx (PPO)
|
$55.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx (PPO)
|
$55.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,481.13 |
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 |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,481.13 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,481.13 |
Browse Plan Formulary |
Health Alliance Medicare PPO10 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
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 |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
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 |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
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 |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
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 |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
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 |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
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 |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
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 |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
3 |
Tier 3 |
$88.00 | $264.00 | None | $2,478.51 |
Browse Plan Formulary |