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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.70 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,062.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,139.61 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,058.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.18 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,141.68 |
Browse Plan Formulary |
HumanaChoice H6609-005 (PPO)
|
$36.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,061.68 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,067.77 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,067.77 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,067.77 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,067.77 |
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 |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,067.77 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,067.77 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,066.15 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Std Rx - MN
|
$38.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.48 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std. Rx -
|
$38.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.48 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Enhanced w/Enhanced
|
$67.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | P | $1,065.48 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | P | $1,151.07 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | P | $1,151.07 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | P | $1,151.07 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | P | $1,151.07 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | P | $1,151.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | P | $1,151.07 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $105.00 | P | $1,151.07 |
Browse Plan Formulary |