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 |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
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 |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE AR Plan 2 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $57,336.90 |
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 |
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 |
Windsor Medicare Extra Emerald Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | n/a |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,068.50 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $61,352.90 |
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 |
Windsor Medicare Extra Gold Plan (HMO)
|
$15.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | n/a |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$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 |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$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 |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Plus Point (HMO-
|
$15.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $60,629.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$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
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $60,745.10 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
AR Blue Cross - Medi-Pak Advantage MA-PD O
|
$21.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $62,008.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$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 H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$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 H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$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 H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-009 (PFFS)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
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 | $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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 Four (P
|
$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 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 | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $61,529.90 |
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 | $61,529.90 |
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 | $61,529.90 |
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 | $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 |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$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 H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$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 H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$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 H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$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 H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$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 H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$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 H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-010 (PFFS)
|
$23.20 |
$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 H2944-010 (PFFS)
|
$23.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $60,700.30 |
Browse Plan Formulary |
Windsor Medicare Extra Diamond Plan (HMO)
|
$25.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | n/a |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
|
$27.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | n/a |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$27.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | n/a |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$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 |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$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 |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$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 |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $60,629.90 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$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 |
HumanaChoice R5826-010 (Regional PPO)
|
$30.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $60,700.30 |
Browse Plan Formulary |