CELLCEPT CAPSULES 250MG (500 CT) (500 BOT) (NDC: 00004025943)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | P | $1,061.51 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $215.00 | P | $1,062.30 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $215.00 | P | $1,062.30 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,062.30 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,062.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,062.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,061.80 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | P | $1,064.00 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$13.70 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,062.16 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$13.70 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,062.16 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$16.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P | $1,063.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$17.30 |
$0 |
to be determined |
3 |
Tier 3 |
$54.00 | $152.00 | P | $1,060.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$18.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P | $1,063.42 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1468-007 (HMO)
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.03 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | P | $1,064.26 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | P | $1,064.26 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | P | $1,064.26 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | P | $1,064.26 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | P | $1,064.26 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | P | $1,064.26 |
Browse Plan Formulary |
HumanaChoice H1418-011 (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
HumanaChoice H1418-011 (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
HumanaChoice H1418-012 (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,061.08 |
Browse Plan Formulary |
HumanaChoice H1418-014 (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P | $1,066.74 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | P | $1,066.74 |
Browse Plan Formulary |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,056.88 |
Browse Plan Formulary |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,056.88 |
Browse Plan Formulary |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,056.88 |
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 |
HumanaChoice H1418-010 (PPO)
|
$26.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-043 (PFFS)
|
$31.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,062.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,046.75 |
Browse Plan Formulary |
HumanaChoice R5826-009 (Regional PPO)
|
$34.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,055.03 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.72 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.72 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.72 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.72 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.72 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO10 Rx (PPO)
|
$55.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx (PPO)
|
$55.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO10 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $117.00 | P | $1,094.78 |
Browse Plan Formulary |