FELBATOL 600MG/5ML SUSP (32 FLO BOT) (NDC: 00037044217)
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 |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$79.00 | $227.00 | None | $1,143.51 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,222.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,222.08 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,218.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,218.48 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,163.15 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,163.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,223.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,223.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,218.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,218.48 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$55.00 | $137.50 | None | $1,150.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,234.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,234.50 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | None | $1,271.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,234.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,234.50 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,202.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,202.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,202.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,202.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,202.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,202.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,220.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
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 | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,255.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-109 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,117.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,103.12 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | None | $1,150.45 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | None | $1,150.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | None | $1,150.45 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | None | $1,150.45 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | None | $1,150.45 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | None | $1,150.45 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | None | $1,150.45 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $180.00 | None | $1,240.32 |
Browse Plan Formulary |
HumanaChoice R5826-001 (Regional PPO)
|
$36.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,152.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,222.08 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,222.08 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | None | $1,140.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,254.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,256.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,219.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,249.54 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,254.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,256.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,223.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,223.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,225.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,240.90 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $1,140.64 |
Browse Plan Formulary |