CLEOCIN HCL 300MG CAPSULE (100 BOT) (NDC: 00009039514)
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,016.78 |
Browse Plan Formulary |
HumanaChoice H5868-001 (PPO)
|
$8.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |