CELEBREX 100MG CAPSULE (500 BOT) (NDC: 00025152051)
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 |
Aetna Medicare Dual Advantage Plan (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P Q:2 /1Days | $143.47 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $142.71 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $142.71 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $142.71 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $142.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $142.71 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.69 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.69 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
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 |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.51 |
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 |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $143.55 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.69 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.69 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.69 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.69 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.71 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.71 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:62 /31Days | $141.68 |
Browse Plan Formulary |
HumanaChoice H4520-006 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $107.50 | S Q:60 /30Days | $140.13 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $50.00 | Q:180 /90Days | $143.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $50.00 | Q:180 /90Days | $143.55 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $142.72 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:60 /30Days | $145.62 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $151.79 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.81 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | P | $143.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $140.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.27 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.27 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.94 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.50 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.27 |
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 |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.27 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $141.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $142.01 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (R
|
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $143.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | S Q:60 /30Days | $140.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.56 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $120.00 | S Q:60 /30Days | $142.68 |
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 |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $120.00 | S Q:60 /30Days | $142.68 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $120.00 | S Q:60 /30Days | $142.68 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.50 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$19.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.25 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $146.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $144.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $145.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:60 /30Days | $147.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $143.58 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $143.53 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $143.53 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $143.53 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $143.53 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $143.53 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $143.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
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 |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | Q:180 /90Days | $143.46 |
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 |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S Q:60 /30Days | $141.38 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S Q:60 /30Days | $141.38 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S Q:60 /30Days | $139.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.48 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.76 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.69 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days | $143.65 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:180 /90Days | $143.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Silver Rx (Regional
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $107.50 | P | $143.55 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
$95.00 | $285.00 | P | $142.72 |
Browse Plan Formulary |
Physicians Health Choice Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | Q:60 /30Days | $145.80 |
Browse Plan Formulary |
Physicians Health Choice Select (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | Q:60 /30Days | $145.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.60 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.60 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.60 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $142.60 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $60.00 | Q:60 /30Days | $145.62 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $60.00 | Q:60 /30Days | $145.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $60.00 | Q:60 /30Days | $145.62 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $60.00 | Q:60 /30Days | $145.62 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $60.00 | Q:60 /30Days | $145.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.88 |
Browse Plan Formulary |
HumanaChoice R5826-075 (Regional PPO)
|
$33.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $140.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | S Q:60 /30Days | $140.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P Q:2 /1Days | $142.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P Q:2 /1Days | $142.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | S | $149.99 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$40.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.40 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P Q:2 /1Days | $143.38 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P Q:2 /1Days | $143.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | S | $149.99 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | P Q:2 /1Days | $143.68 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | P Q:2 /1Days | $143.68 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | P Q:2 /1Days | $143.68 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | P Q:2 /1Days | $143.68 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | Q:93 /31Days | $141.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $144.97 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.80 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.80 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.80 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.80 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.80 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S | $147.25 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.56 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.56 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.56 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.56 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.56 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $145.13 |
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)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:60 /30Days | $142.92 |
Browse Plan Formulary |