EMCYT 140MG CAPSULE (100 BOTPL) (NDC: 00013013202)
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $1,073.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,018.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,018.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$7.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,015.19 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,018.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $997.67 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $997.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $997.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $997.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $997.67 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$20.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $998.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,024.49 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,024.49 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,024.49 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,024.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,017.94 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
|
$24.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $985.27 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $997.29 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $1,003.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,015.19 |
Browse Plan Formulary |
HumanaChoice H5470-004 (PPO)
|
$27.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $994.67 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $90.00 | None | $1,006.75 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $90.00 | None | $1,006.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $960.72 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$33.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $995.62 |
Browse Plan Formulary |
Plan Name |
Monthly 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 R5826-072 (Regional PPO)
|
$33.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $995.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $999.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $999.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $999.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $999.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $999.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $999.51 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $999.51 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,024.74 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,024.74 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,024.74 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $1,006.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $1,006.75 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $1,006.75 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $1,006.75 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $1,006.75 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $992.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,018.18 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.97 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.97 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.97 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.97 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.97 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,058.97 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.14 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,018.62 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,012.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,002.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,021.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,023.07 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.97 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.97 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,057.08 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.32 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,058.97 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,025.53 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,025.53 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,025.53 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,025.53 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,019.65 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $999.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $1,016.57 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $1,000.95 |
Browse Plan Formulary |