CHORIONIC GONAD 10000U VIAL (10 X 10 ML PKGCOM) (NDC: 63323002510)
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 |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$0.00 |
$150 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $932.50 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | P | $1,028.35 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,349.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$11.40 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.50 | P | $959.07 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.20 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | P | $1,028.35 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | P | $976.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$18.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | P | $1,000.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
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 |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$25.80 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | P | $1,028.35 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$27.00 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $75.00 | P | $1,028.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$27.00 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $75.00 | P | $1,028.35 |
Browse Plan Formulary |
HumanaChoice H7188-003 (PPO)
|
$27.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $976.78 |
Browse Plan Formulary |
HumanaChoice R5826-010 (Regional PPO)
|
$30.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,349.88 |
Browse Plan Formulary |