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 |
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 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,612.04 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$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)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 1 |
Tier 1 |
n/a | n/a | Q:10 /25Days | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 1 |
Tier 1 |
n/a | n/a | Q:10 /25Days | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 1 |
Tier 1 |
n/a | n/a | Q:10 /25Days | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 1 |
Tier 1 |
n/a | n/a | Q:10 /25Days | n/a |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | $24.00 | Q:10 /25Days | $1,554.04 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | $24.00 | Q:10 /25Days | $1,594.05 |
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 | $1,683.93 |
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 | $1,683.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,683.93 |
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 | $1,683.93 |
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 | $1,683.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
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
|
$6.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,690.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,690.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,713.90 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,713.90 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,713.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,713.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,713.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,713.90 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,690.15 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,690.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,717.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,717.81 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,687.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,687.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,687.56 |
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 | $1,693.38 |
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 | $1,693.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,686.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,686.03 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,694.98 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.16 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,703.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
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 |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,724.21 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,618.09 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:15 /31Days | $1,618.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
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
|
$22.40 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,701.63 |
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 |
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 | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,636.19 |
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 |
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 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 |
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 Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | Q:20 /30Days | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
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 | $1,649.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
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 |
Plan Name |
Monthly 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 |
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 | $1,630.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
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 | $1,630.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $1,630.06 |
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 | $1,630.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,165.90 |
Browse Plan Formulary |
HumanaChoice R5826-079 (Regional PPO)
|
$25.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,217.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,693.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,693.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,693.38 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,271.90 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Advantra Platinum (PPO)
|
$30.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $1,651.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,219.42 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:10 /25Days | $1,607.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:10 /25Days | $1,607.67 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:10 /25Days | $1,607.67 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:10 /25Days | $1,607.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$38.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,696.77 |
Browse Plan Formulary |
HumanaChoice R5826-003 (Regional PPO)
|
$39.20 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:20 /30Days | $2,217.51 |
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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | Q:15 /30Days | $1,723.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,698.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.91 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
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 |
Plan Name |
Monthly 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 | $1,490.82 |
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 |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,687.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,687.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$47.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,687.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,717.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,717.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,707.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,686.03 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,686.03 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$55.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$60.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | Q:15 /31Days | $1,617.68 |
Browse Plan Formulary |