EPOGEN 4000U/ML VIAL SDV (10 X 1 ML VIALS VIALSD) (NDC: 55513014810)
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P Q:30 /31Days | $1,062.24 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P Q:30 /31Days | $1,062.24 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P Q:30 /31Days | $1,062.24 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P Q:30 /31Days | $1,062.24 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P Q:30 /31Days | $1,062.24 |
Browse Plan Formulary |
Humana Gold Plus H3028-001 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H6411-007 (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Lovelace Senior Plan -- Standard Plan (HMO
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$36.00 | $108.00 | P | $1,062.44 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $180.00 | P | $1,049.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,067.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,067.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,067.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,067.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,067.29 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /31Days | $1,066.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-008 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | P Q:14 /30Days | $1,056.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$21.40 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P | n/a |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,136.45 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,120.29 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,228.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,118.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,079.97 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,079.97 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,079.97 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,079.97 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P Q:12 /28Days | $1,079.97 |
Browse Plan Formulary |
Lovelace Senior Plan -- Enhanced Plan (HMO
|
$40.70 |
$0 | to be determined | 2 |
Tier 2 |
$36.00 | $108.00 | P | $1,062.44 |
Browse Plan Formulary |