DIBENZYLINE 10MG CAPSULE (100 BOTPL) (NDC: 65197000101)
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 |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,536.43 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,536.43 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,321.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,336.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,319.75 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,319.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,332.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,332.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,338.86 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
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 |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
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 |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,314.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,336.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,337.14 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,322.40 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,319.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,319.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,335.91 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,314.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-122 (PFFS)
|
$23.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,317.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-122 (PFFS)
|
$23.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,317.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-131 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,317.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-131 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,317.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-132 (PFFS)
|
$24.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,304.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-123 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,304.52 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,335.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.70 |
Browse Plan Formulary |
HumanaChoice R5826-007 (Regional PPO)
|
$28.20 |
$0 |
to be determined |
3 |
Tier 3 |
$82.00 | $205.00 | None | $1,312.94 |
Browse Plan Formulary |
HumanaChoice R5826-080 (Regional PPO)
|
$30.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,312.94 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.14 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,229.90 |
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 |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $1,229.90 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,515.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,516.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,515.74 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,332.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,332.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,346.10 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,338.86 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,229.90 |
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 |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,229.90 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.13 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,466.32 |
Browse Plan Formulary |