COPEGUS 200MG TABLET (168 BOT) (NDC: 00004008694)
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:168 /28Days | $1,568.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,673.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:168 /28Days | $1,574.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:168 /28Days | $1,574.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:168 /28Days | $1,574.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:168 /28Days | $1,574.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:168 /28Days | $1,574.70 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,587.53 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Standard Rx
|
$38.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,601.29 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std Rx -
|
$38.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,601.29 |
Browse Plan Formulary |
Medica Prime Sol. Enhanced w/Enhanced Rx -
|
$67.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $148.00 | None | $1,601.29 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 |
to be determined |
3 |
Tier 3 |
$74.00 | $68.00 | None | $1,601.29 |
Browse Plan Formulary |