CYTOVENE 500MG VIAL (10 ML X 25 VIAL) (NDC: 00004694003)
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 |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $215.00 | P | $1,774.74 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $215.00 | P | $1,774.74 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $215.00 | P | $1,774.74 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,751.25 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,774.74 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,839.97 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,839.97 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,839.97 |
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 |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,839.97 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,839.97 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,839.97 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,839.97 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.16 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.31 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.31 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.31 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,794.08 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.30 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.30 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.30 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,773.52 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
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 |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
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 |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
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 |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | $1,741.16 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,772.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | P | $1,791.83 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (
|
$14.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,751.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,834.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
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 H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
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 |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
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 |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,823.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
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 |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
HumanaChoice H1716-004 (PPO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,796.36 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,797.59 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,774.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,811.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,849.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,794.29 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H2649-015 (HMO)
|
$30.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,743.05 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$33.20 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,751.25 |
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 |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
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 |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
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 |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,741.16 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,806.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,795.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,792.06 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,816.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,806.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,842.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,772.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | P | $1,791.83 |
Browse Plan Formulary |