FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS (5 SYSTEM POU) (NDC: 00378911998)
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 Balance (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | Q:15 /31Days | $1,611.88 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | Q:15 /31Days | $1,611.88 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | Q:15 /31Days | $1,611.88 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | Q:15 /31Days | $1,611.88 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | Q:15 /31Days | $1,611.46 |
Browse Plan Formulary |
Plan Name |
Monthly 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 3 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | Q:15 /31Days | $1,611.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | Q:15 /31Days | $1,611.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,612.16 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,612.16 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | Q:10 /25Days | $1,554.65 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | Q:10 /25Days | $1,554.65 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | Q:10 /25Days | $1,554.65 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | Q:10 /25Days | $1,554.65 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | Q:10 /25Days | $1,554.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,614.98 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,614.98 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,614.98 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | Q:10 /25Days | $1,797.83 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,193.90 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,193.90 |
Browse Plan Formulary |
Healthfirst Medicare Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,460.52 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $1,342.19 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecureHorizons MedicareComplete Choice (Re
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,610.63 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,669.96 |
Browse Plan Formulary |
Medicare Blue Choice Value (HMO)
|
$5.40 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,732.84 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,732.84 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,732.84 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,757.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,324.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,697.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,726.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,726.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,684.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,690.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,327.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,327.87 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,327.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,695.45 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | Q:10 /31Days | $1,613.84 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | Q:10 /31Days | $1,613.84 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | Q:10 /31Days | $1,613.84 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,716.27 |
Browse Plan Formulary |
Medicare Blue PPO - Plan 201 (PPO)
|
$18.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
2 |
Tier 2 |
$33.00 | $66.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
2 |
Tier 2 |
$33.00 | $66.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Humana Gold Choice H4774-004 (PFFS)
|
$20.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,185.49 |
Browse Plan Formulary |
Medicare Blue Choice Value Plus (HMO)
|
$21.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,405.48 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,358.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $1,315.30 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,647.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,636.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,636.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,636.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,636.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,636.19 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,636.19 |
Browse Plan Formulary |
Evercare Plan RMP (Regional PPO)
|
$23.40 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,610.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,726.83 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:15 /31Days | $1,611.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:15 /31Days | $1,611.59 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:15 /31Days | $1,611.59 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:15 /31Days | $1,611.59 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:15 /31Days | $1,611.59 |
Browse Plan Formulary |
Evercare Plan RDP (Regional PPO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:15 /31Days | $1,610.63 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Blue Choice Senior (Cost)
|
$26.30 |
$110 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,014.30 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
2 |
Tier 2 |
$27.00 | $54.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
2 |
Tier 2 |
$27.00 | $54.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,726.38 |
Browse Plan Formulary |
Humana Gold Choice H4774-003 (PFFS)
|
$29.60 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,185.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,155.58 |
Browse Plan Formulary |
Medicare Blue Choice Optimum (HMO)
|
$30.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,152.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $1,324.12 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:10 /25Days | $1,554.65 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:10 /25Days | $1,554.65 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,460.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $1,646.49 |
Browse Plan Formulary |
Liberty Health Advantage Dual Power - Nass
|
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $1,554.77 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:10 /25Days | $1,607.07 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:10 /25Days | $1,607.07 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:10 /25Days | $1,607.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,487.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,487.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,487.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,487.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,487.10 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Preferred Gold Rx (HMO)
|
$36.80 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | Q:20 /30Days | $1,746.25 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | S Q:15 /30Days | $1,533.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,690.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,702.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,697.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GoldValue Rx (HMO)
|
$38.70 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $18.00 | Q:20 /30Days | $1,746.25 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Advantage Platinum NY - Suffolk (HMO)
|
$41.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:10 /30Days | $1,621.99 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,487.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,487.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Health Suffolk - SNP (HMO)
|
$44.30 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:10 /30Days | $1,621.99 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,463.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,463.80 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $1,327.87 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $1,327.87 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $1,327.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
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 |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,484.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,484.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,484.46 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
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 |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
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 |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $1,697.40 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,497.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,484.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,484.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:20 /30Days | $1,484.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GoldAnywhere Rx (PPO)
|
$60.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | Q:20 /30Days | $1,746.25 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$70.20 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.63 |
Browse Plan Formulary |