CELLCEPT CAPSULES 250MG (500 CT) (500 BOT) (NDC: 00004025943)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $212.00 | P | $1,061.18 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | P | $993.69 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | P | $993.69 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | P | $993.69 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | P | $993.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,063.36 |
Browse Plan Formulary |
Humana Gold Choice H1804-290 (PFFS)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,055.68 |
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 |
Clear Care Vital (HMO)
|
$10.00 |
$310 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $1,097.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,079.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$12.20 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $170.00 | P | $1,060.12 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$17.50 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $212.00 | P | $1,061.63 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$19.30 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,060.94 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$19.30 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,060.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$19.30 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,060.94 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$19.30 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,060.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,085.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,081.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,078.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,106.12 |
Browse Plan Formulary |
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 |
Clear Care Essential (HMO)
|
$27.40 |
$310 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $1,097.96 |
Browse Plan Formulary |
Spokane Community Care - Enhanced (HMO)
|
$35.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Spokane Community Care - Enhanced (HMO)
|
$35.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.67 |
Browse Plan Formulary |
Spokane Community Care - Enhanced (HMO)
|
$35.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.67 |
Browse Plan Formulary |
Spokane Community Care - Enhanced (HMO)
|
$35.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-063 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-064 (PFFS)
|
$36.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,055.68 |
Browse Plan Formulary |
Spokane Community Care - Premier (HMO)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | P | $1,069.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Regence MedAdvantage + Rx Classic (PPO)
|
$38.80 |
$255 |
to be determined |
3 |
Tier 3 |
$56.00 | $168.00 | P | $138.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,062.59 |
Browse Plan Formulary |
Clear Care Optimal (HMO)
|
$40.10 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $1,097.96 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,058.63 |
Browse Plan Formulary |
Regence MedAdvantage + Rx Enhanced (PPO)
|
$66.60 |
$0 |
to be determined |
3 |
Tier 3 |
$56.00 | $168.00 | P | $138.81 |
Browse Plan Formulary |