EPOGEN INJECTION 40000U 10 X 4ML VIALS VIALSD (10 X 4 ML VIALS VIALSD) (NDC: 55513082310)
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 |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $10,938.80 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $10,949.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $11,906.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $10,949.10 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,376.80 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,376.80 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,230.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,176.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,877.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $11,355.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,081.80 |
Browse Plan Formulary |
HumanaChoice R5826-079 (Regional PPO)
|
$25.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $10,987.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $11,025.00 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P S Q:4 /28Days | $10,890.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,631.60 |
Browse Plan Formulary |
HumanaChoice R5826-003 (Regional PPO)
|
$39.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $10,987.90 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
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 |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $11,003.70 |
Browse Plan Formulary |