D.H.E.45 1MG/ML AMPUL (10 AMP BLPK CRTN) (NDC: 66490004101)
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 |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $1,028.06 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,181.09 |
Browse Plan Formulary |
HumanaChoice H1806-006 (PPO)
|
$20.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H1806-006 (PPO)
|
$20.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
HumanaChoice H1806-006 (PPO)
|
$20.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
HumanaChoice H1806-006 (PPO)
|
$20.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
HumanaChoice H1806-006 (PPO)
|
$20.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-120 (PFFS)
|
$22.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-127 (PFFS)
|
$25.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
HumanaChoice H1806-002 (PPO)
|
$28.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-128 (PFFS)
|
$35.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-128 (PFFS)
|
$35.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-128 (PFFS)
|
$35.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-128 (PFFS)
|
$35.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-128 (PFFS)
|
$35.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $1,040.27 |
Browse Plan Formulary |