DIOVAN 40MG TABLET (30 BOT) (NDC: 00078042315)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $123.97 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | S Q:180 /90Days | $124.92 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (HMO)
|
$7.30 |
$100 | to be determined | 2 |
Tier 2 |
$37.00 | $93.00 | None | $124.86 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $127.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $127.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $127.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:180 /90Days | $124.72 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$37.00 | $74.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$17.80 |
$100 | to be determined | 3 |
Tier 3 |
$28.00 | $56.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $131.70 |
Browse Plan Formulary |
Bravo Premier Plus (HMO-POS)
|
$22.20 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.89 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$29.40 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | S Q:180 /90Days | $124.84 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.65 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.65 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.65 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | S Q:180 /90Days | $124.65 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO)
|
$30.20 |
$310 | to be determined | 3 |
Tier 3 |
$47.00 | $94.00 | None | $123.97 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Traditions (HMO)
|
$33.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | S Q:180 /90Days | $124.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $127.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $127.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $127.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $126.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:2 /1Days | $125.89 |
Browse Plan Formulary |