CELEBREX 50MG CAPSULE (60 BOT) (NDC: 00025151501)
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 |
Humana Gold Plus H2949-002 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$41.00 | $102.50 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Humana Gold Plus H2949-007 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $66.95 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $66.95 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:62 /31Days | $66.95 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $71.87 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $71.87 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $71.87 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $71.87 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $71.87 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $71.87 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 | $71.87 |
Browse Plan Formulary |
Senior Dimensions Greater Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | S Q:60 /30Days | $68.35 |
Browse Plan Formulary |
Senior Dimensions Northern Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | S Q:60 /30Days | $68.35 |
Browse Plan Formulary |
Senior Dimensions Southern Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | S Q:60 /30Days | $68.35 |
Browse Plan Formulary |
Senior Dimensions Southern Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | S Q:60 /30Days | $68.35 |
Browse Plan Formulary |
Sierra Nevada Spectrum (Regional PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | S Q:60 /30Days | $68.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra VillageHealth (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | S Q:60 /30Days | $68.35 |
Browse Plan Formulary |
Spectrum Care Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | S Q:60 /30Days | $68.35 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $67.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $67.79 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $67.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $67.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.96 |
Browse Plan Formulary |
Anthem Medicare Preferred Premier (PPO)
|
$20.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Preferred Premier (PPO)
|
$20.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $67.79 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | P Q:60 /30Days | $58.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:60 /30Days | $66.58 |
Browse Plan Formulary |
HumanaChoice H9503-003 (PPO)
|
$33.80 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.15 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.15 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.15 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.15 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | S | $71.15 |
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 |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | S Q:60 /30Days | $66.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $71.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.15 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.15 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.15 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.14 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | S | $71.15 |
Browse Plan Formulary |