DEPO-PROVERA 150MG/ML VIAL (25 X 1 ML VIAL) (NDC: 00009074635)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,788.93 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,788.93 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,788.93 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,788.93 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,788.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,898.96 |
Browse Plan Formulary |
Texas Community Care- Plus (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
$69.00 | $138.00 | None | $1,799.64 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Plus H4510-020 (HMO)
|
$9.90 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | Q:1 /90Days | $1,778.22 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,757.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,756.95 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:1 /90Days | $1,771.37 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,789.76 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,765.47 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,765.47 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,765.47 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,765.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,758.16 |
Browse Plan Formulary |
HumanaChoice R5826-075 (Regional PPO)
|
$33.10 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:1 /90Days | $1,757.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,767.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-003 (PPO)
|
$46.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days | $1,778.22 |
Browse Plan Formulary |