COSMEGEN 0.5MG VIAL (12 VIAL) (NDC: 67386081155)
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 |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
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 |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Amerivantage Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
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 |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $596.77 |
Browse Plan Formulary |
Bravo Choice (HMO)
![Email Prescription and/or Health Benefit details for Bravo Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $617.23 |
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 |
Bravo Choice (HMO)
![Email Prescription and/or Health Benefit details for Bravo Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $617.23 |
Browse Plan Formulary |
Bravo Choice (HMO)
![Email Prescription and/or Health Benefit details for Bravo Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $617.23 |
Browse Plan Formulary |
Bravo Choice (HMO)
![Email Prescription and/or Health Benefit details for Bravo Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $617.23 |
Browse Plan Formulary |
Bravo Choice (HMO)
![Email Prescription and/or Health Benefit details for Bravo Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $617.23 |
Browse Plan Formulary |
Bravo Choice (HMO)
![Email Prescription and/or Health Benefit details for Bravo Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $617.23 |
Browse Plan Formulary |
Bravo Choice (HMO)
![Email Prescription and/or Health Benefit details for Bravo Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $617.23 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $594.29 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $516.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
![Email Prescription and/or Health Benefit details for Bravo Liberty II Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $602.99 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
![Email Prescription and/or Health Benefit details for Bravo Liberty II Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $602.99 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
![Email Prescription and/or Health Benefit details for Bravo Liberty II Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $602.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
![Email Prescription and/or Health Benefit details for Bravo Liberty II Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $602.99 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
![Email Prescription and/or Health Benefit details for Bravo Liberty II Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | P | $602.99 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan IP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $616.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $595.89 |
Browse Plan Formulary |