ELOXATIN 100MG/20ML VIAL (1 X 20 ML VIALSU) (NDC: 00024059120)
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 HMO Standard (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $60,928.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $65,632.80 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
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 |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $63,514.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $66,678.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $62,038.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-079 (Regional PPO)
|
$25.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
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 |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
HumanaChoice R5826-003 (Regional PPO)
|
$39.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $61,068.40 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | n/a |
Browse Plan Formulary |
Blue Medicare HMO Enhanced (HMO)
|
$59.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $60,928.40 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Blue Medicare PPO Enhanced (PPO)
|
$85.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $60,928.40 |
Browse Plan Formulary |
Blue Medicare PPO Enhanced Freedom (PPO)
|
$90.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $60,928.40 |
Browse Plan Formulary |