EPOGEN INJECTION 20000U 10 X 1ML CRTN (10 X 1ML CRTN) (NDC: 55513047810)
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 |
Advantra Platinum PPO (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,297.54 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Silver (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,297.54 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:12 /28Days | $5,165.13 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,304.19 |
Browse Plan Formulary |
Plan Name |
Monthly 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 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,304.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,304.19 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,304.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $5,645.72 |
Browse Plan Formulary |
MedicareBlue PPO (Regional PPO)
|
$5.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $5,398.05 |
Browse Plan Formulary |
HumanaChoice H5868-001 (PPO)
|
$8.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,219.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,308.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $5,326.82 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $5,225.47 |
Browse Plan Formulary |