CIMZIA KIT (NDC: 50474070062)
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 |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
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 |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
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 |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
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 |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
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 |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $1,643.35 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,565.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,547.22 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,565.22 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,590.90 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,619.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,585.29 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
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 | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,622.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$28.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,565.22 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$28.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,565.22 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,565.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
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 |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-012 (HMO)
|
$34.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Diamond (PPO)
|
$37.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Ruby (PPO)
|
$37.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
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 |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,659.09 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | P | $1,595.96 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
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 Plus H4461-016 (HMO)
|
$55.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:6 /30Days | $1,583.77 |
Browse Plan Formulary |