DEMECLOCYCLINE HCL 300MG TABLET (48 BOT) (NDC: 00555070284)
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 Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $703.78 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $710.26 |
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
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $710.26 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $688.78 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $688.78 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,001.02 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,001.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $708.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $708.90 |
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 |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
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 |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
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 |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $688.78 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $688.78 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
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 |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.00 | $18.00 | None | $1,033.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:42 /1Days | $725.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $593.04 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
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 H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
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 |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,033.26 |
Browse Plan Formulary |
HumanaChoice H1681-007 (PPO)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | None | $706.42 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
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 |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $21.00 | None | $1,033.26 |
Browse Plan Formulary |
HumanaChoice H1681-001 (PPO)
|
$34.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $706.42 |
Browse Plan Formulary |
HumanaChoice R5826-001 (Regional PPO)
|
$36.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $706.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $710.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $710.26 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
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 |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
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 |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $899.31 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
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 |
4 |
Tier 4 |
33% | n/a | P | $707.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
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 |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $674.10 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $673.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $708.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $708.90 |
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 |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
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 |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $686.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
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 |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
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 |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $700.19 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
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 |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
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 |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
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 |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $894.48 |
Browse Plan Formulary |