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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,579.38 |
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 |
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 |
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 |
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
|
$6.30 |
$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
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,704.16 |
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 |
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 |
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 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
HealthPartners Freedom Plan II Standard Rx
|
$7.10 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
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
|
$10.30 |
$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
|
$10.30 |
$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
|
$10.30 |
$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 |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,699.14 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,699.14 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,699.14 |
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
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,687.56 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:15 /31Days | $1,616.41 |
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
|
$13.60 |
$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
|
$13.60 |
$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
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | Q:16 /30Days | $1,686.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
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 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 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 |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
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 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 |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom Plan III StandardRx
|
$14.60 |
$100* |
to be determined |
1* |
Tier 1 |
$9.00 | $18.00 | None | $1,561.18 |
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
|
$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
|
$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
|
$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
|
$16.60 |
$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 |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,699.14 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,699.14 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | Q:16 /30Days | $1,699.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:15 /30Days | $1,688.89 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:20 /30Days | $2,178.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | Q:20 /30Days | $2,218.28 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $1,587.50 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | P Q:10 /30Days | $1,579.38 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | Q:15 /30Days | $1,435.60 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,611.41 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P Q:10 /30Days | $1,586.55 |
Browse Plan Formulary |
AbilityCare (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,599.42 |
Browse Plan Formulary |
AbilityCare (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,599.42 |
Browse Plan Formulary |
AbilityCare (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,599.42 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | Q:20 /30Days | $2,219.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | Q:20 /30Days | $2,219.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | Q:20 /30Days | $2,219.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | Q:20 /30Days | $2,219.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | Q:20 /30Days | $2,219.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | Q:20 /30Days | $2,219.64 |
Browse Plan Formulary |
SeniorCare Complete (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,599.42 |
Browse Plan Formulary |
SeniorCare Complete (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,599.42 |
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 |
SeniorCare Complete (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:15 /30Days | $1,599.42 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,576.98 |
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 |
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 |
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 |
Medica Prime Solution Basic w/Std Rx - MN
|
$38.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,581.06 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std. Rx -
|
$38.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,581.06 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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 | $1,491.45 |
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 |
Plan Name |
Monthly 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
|
$44.10 |
$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
|
$44.10 |
$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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,491.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $1,490.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
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 | $1,707.82 |
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
|
$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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
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 |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
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 |
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 |
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 |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
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 |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,581.06 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Enhanced
|
$67.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:10 /30Days | $1,581.06 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | Q:10 /25Days | $1,817.57 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | Q:10 /25Days | $1,817.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | Q:10 /25Days | $1,817.57 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | Q:10 /25Days | $1,817.57 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | Q:10 /25Days | $1,817.57 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | Q:10 /25Days | $1,817.57 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | Q:10 /25Days | $1,817.57 |
Browse Plan Formulary |
HealthPartners Freedom Plan III EnhancedRx
|
$167.50 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $1,561.18 |
Browse Plan Formulary |