CILOXAN 0.3% OINTMENT (3.5 GM TUBE) (NDC: 00065065435)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Humana Gold Plus H2949-002 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.10 |
Browse Plan Formulary |
Humana Gold Plus H2949-007 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $81.77 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $81.77 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $81.77 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.24 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.24 |
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 | Q:8 /30Days | $87.24 |
Browse Plan Formulary |
Senior Dimensions Greater Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | n/a | Q:4 /30Days | $73.47 |
Browse Plan Formulary |
Senior Dimensions Northern Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | n/a | Q:4 /30Days | $73.47 |
Browse Plan Formulary |
Senior Dimensions Southern Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | n/a | Q:4 /30Days | $73.47 |
Browse Plan Formulary |
Senior Dimensions Southern Nevada Plan (HM
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | n/a | Q:4 /30Days | $73.47 |
Browse Plan Formulary |
Sierra Nevada Spectrum (Regional PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | n/a | Q:4 /30Days | $73.47 |
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 |
Sierra VillageHealth (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | n/a | Q:4 /30Days | $73.47 |
Browse Plan Formulary |
Spectrum Care Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | n/a | Q:4 /30Days | $73.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $84.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $84.29 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
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 |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
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 |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$7.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $84.01 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $84.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.90 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $82.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $84.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $84.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Preferred Premier (PPO)
|
$20.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.87 |
Browse Plan Formulary |
Anthem Medicare Preferred Premier (PPO)
|
$20.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.87 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $82.70 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.87 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:8 /30Days | $87.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
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 | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
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 | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
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 | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $76.32 |
Browse Plan Formulary |
HumanaChoice H9503-003 (PPO)
|
$33.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $75.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.18 |
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 H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-053 (PFFS)
|
$43.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $76.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $84.01 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $84.01 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.90 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:4 /30Days | $83.90 |
Browse Plan Formulary |